NPIMap

Individual provider Active NPI

Shintaro Chiba, M.D.

  • Surgery Physician
  • Loma Linda, CA
National Provider Identifier
1912264763
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
S3504 Issued in TX
Practice address
11175 Campus Street
Coleman Pavilion 21111
Loma Linda, CA 92354
Phone
(347) 446-4228
NPI assigned
Apr 18, 2012
Last updated
Jun 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A153896 CA
Surgery Physician 208600000X S3504 TX Primary

Addresses

Primary practice location

11175 Campus Street
Coleman Pavilion 21111
Loma Linda, CA 92354

Mailing address

2000 Trans Mountain Rd Ste B
El Paso, TX 79911-3602
Phone (915) 215-8000

Other practice location 1

4802 10th Ave
Maimonides Medical Center
Brooklyn, NY 11219
Phone (718) 283-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191007003088 TX Practitioner - General Surgery 6204185069 Reassigns benefits to 1 organization
I20241217001821 WV Practitioner - General Surgery 6204185069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Medical Ctr Dr
Morgantown, WV 26506-1200
Phone (304) 293-4500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)11
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A153896CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation CurrentSince Dec 31, 2024 Accepting new patients
West Virginia University Medical Corporation Surgery CurrentSince Dec 31, 2024 Accepting new patients
Texas Tech University Health Sciences Center El Paso CurrentSince Oct 1, 2019 Accepting new patients
Texas Tech University Health Sciences Center El Paso Surgery CurrentSince Oct 1, 2019 Accepting new patients
Texas Tech University Health Sciences Center El Paso Current Accepting new patients
West Virginia University Hospitals, Inc Past Accepting new patients

Locations

4801 Alberta Ave
El Paso, TX 79905
Phone (915) 215-5200

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

Organizations & group practices 6

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590969600000",
    "number": "1912264763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 TRANS MOUNTAIN RD STE B",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799113602",
            "telephone_number": "915-215-8000",
            "fax_number": "915-215-8674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11175 CAMPUS STREET",
            "address_2": "COLEMAN PAVILION 21111",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92354",
            "telephone_number": "347-446-4228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4802 10th Ave",
            "address_2": "Maimonides Medical Center",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11219",
            "country_code": "US",
            "telephone_number": "718-283-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHIBA",
        "first_name": "SHINTARO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-18",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A153896",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "S3504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.