NPIMap

Organization Active NPI

Stephen R Shea, M.D., Inc

  • Emergency Medicine Physician
  • San Pedro, CA
National Provider Identifier
1942239033
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
STEPHEN R SHEA, M.D., INC
Practice address
1300 W 7TH St
San Pedro, CA 90732-3505
Phone
(310) 514-5350
Fax
(310) 514-5421
NPI assigned
Jul 1, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Stephen R Shea, M.D.
Title
Owner
Phone
(310) 514-5350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X CA Primary

Addresses

Primary practice location

1300 W 7TH St
San Pedro, CA 90732-3505

Mailing address

444 East Huntington Drive
Suite 300
Arcadia, CA 91006-3778
Phone (626) 447-0296

Other identifiers 1

IdentifierTypeStateIssuer
GR0059780MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422001706 CA Part B Supplier - Clinic/Group Practice 7416854377 Receives reassigned benefits from 61 practitioners
1 other NPI on this enrollment
Practice locations: Long Beach, CA; San Pedro, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1942239033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 EAST HUNTINGTON DRIVE",
            "address_2": "SUITE 300",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910063778",
            "telephone_number": "626-447-0296",
            "fax_number": "626-447-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W 7TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323505",
            "telephone_number": "310-514-5350",
            "fax_number": "310-514-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN R SHEA, M.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SHEA",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-514-5350",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0059780",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.