Mark R Shelly, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

E3427 Issued in CA

Practice address

17609 Ventura Blvd
Ste 210
Encino, CA 91316-5123

Phone

(818) 708-7668

Fax

(818) 708-9668

NPI assigned

Mar 21, 2007

Last updated

Feb 14, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

California School of Podiatric Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coast to Coast Foot DoctorsGroup PAC ID 3072971100, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coast to Coast Foot Doctors

  • Podiatrist
  • Tarzana, CA
  • NPI 1558064246

  Foot & Ankle Surgery

  Medicare reassignment Care Compare group NPD Authorized official
• PLS Foot Doctors

  • Podiatrist
  • Tarzana, CA
  • NPI 1285337972
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487030400000",
    "number": "1902922149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13652 CANTARA ST",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914025423",
            "telephone_number": "818-375-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17609 VENTURA BLVD",
            "address_2": "STE 210",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913165123",
            "telephone_number": "818-708-7668",
            "fax_number": "818-708-9668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLY",
        "first_name": "MARK",
        "middle_name": "R",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2017-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E3427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shahin E Sheibani-Rad, M.D.
• Leslie Shein, MA
• Ross Charles Shelden, DDS
• Sheldon H. Katz, DDS, Inc. (Sheldon H. Katz, D.D.S.)
• Judith Shell, PHD
• Sheltercare Services & Staffing, Inc.
• Veronica Colene Shelton
• Peggy Shen, M.D.
• Melissa Micheli Shepherd-Williams
• Anoush Sherbetchyan

• Foot & Ankle Surgery Podiatrist in Encino, CA
• Providers in Encino, CA by specialty
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.