Russ T Shimizu, M.D., Inc.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

C33305 Issued in CA

Legal business name

RUSS T SHIMIZU, M.D., INC.

Practice address

2811 Wilshire Blvd Ste 550
Santa Monica, CA 90403-4806

Phone

(310) 829-5968

Fax

(310) 453-3685

NPI assigned

Jun 9, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Russ T Shimizu, M.D.NPI 1780688242

Title

Owner

Phone

(310) 829-5968

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Russ T Shimizu, M.D.

  • Neurology Physician
  • Santa Monica, CA
  • NPI 1780688242
  Medicare reassignment NPD Authorized official
• Peter Alan Bardwick, MD

  • Rheumatology Physician
  • Santa Monica, CA
  • NPI 1184799108
  NPD (past)
• Edward J O'Connor, M.D.

  • Neurology Physician
  • Santa Monica, CA
  • NPI 1568466555
  NPD (past)

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613001600000",
    "number": "1912167461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 WILSHIRE BLVD STE 550",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034806",
            "telephone_number": "310-323-0026",
            "fax_number": "310-453-3685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 WILSHIRE BLVD STE 550",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034806",
            "telephone_number": "310-829-5968",
            "fax_number": "310-453-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSS T SHIMIZU, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "SHIMIZU",
        "authorized_official_first_name": "RUSS",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-829-5968",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "C33305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "C33305",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00C333052",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caio Augusto Ruiz
• Janet Ruiz, DPT
• Tamara Michele Rumburg, PSY.D.
• Allison Anne Rummell
• Bruce A. Rush, PSY.D.
• Alex Jules Russan, LMFT
• Margaret Louise Russell, PH.D.
• Michael David Russell, MD, MBA, MPH
• Megan Rustad, DDS
• Christopher Harrison Ruth, DAOM, LAC

• Neurology Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.