NPIMap

Organization Active NPI

Shine Medical of Ca PC

  • Psychiatry Physician
  • San Jose, CA
National Provider Identifier
1942935473
Registry record updated Sep 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SHINE MEDICAL OF CA PC
Practice address
325 S 1St St Ste 200
San Jose, CA 95113-2835
Phone
(888) 380-2028
NPI assigned
Jul 19, 2022
Last updated
Sep 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2026

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

Authorized official

Name
Clare Frances Boals Frye
Title
SVP of Operations
Phone
(616) 648-1196

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

325 S 1St St Ste 200
San Jose, CA 95113-2835

Mailing address

PO Box 52475
Phoenix, AZ 85072-2475

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250325001025 CA Part B Supplier - Clinic/Group Practice 0143743773 Receives reassigned benefits from 23 practitioners
Practice locations: San Jose, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 191

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 191

NPI Registry JSON

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

{
    "created_epoch": "1658188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789430400000",
    "number": "1942935473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52475",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850722475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 S 1ST ST STE 200",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951132835",
            "telephone_number": "888-380-2028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE MEDICAL OF CA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-19",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A",
        "authorized_official_last_name": "FRYE",
        "authorized_official_first_name": "CLARE",
        "authorized_official_middle_name": "FRANCES BOALS",
        "authorized_official_title_or_position": "SVP OF OPERATIONS",
        "authorized_official_telephone_number": "616-648-1196"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2026; 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.