Jenan Nadim Shukry, MD

Primary specialty

Vascular Neurology PhysicianTaxonomy code 2084V0102X

License

A198119 Issued in CA

Practice address

72780 Country Club Dr Ste 205
Rancho Mirage, CA 92270-4150

Phone

(760) 834-3540

Fax

(760) 834-3590

NPI assigned

Mar 27, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Eisenhower Medical Center

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1013981554

  CA

  Medicare reassignment Care Compare group NPD
• Eisenhower Medical Center

  • General Acute Care Hospital
  • Cathedral City, CA
  • NPI 1629384615
  NPD
• Eisenhower Medical Center

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1710272893
  NPD

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

• Eisenhower Medical Center

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1013981554

  Hospital

  Care Compare affiliation
• Healthy Living at Home - Palm Desert LLC

  • Home Health Agency
  • Palm Desert, CA
  • NPI 1265848683
  Care Compare affiliation

Specialty

Vascular Surgery

Education

R Franklin University of Med & Sci/Chicago Medical School, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Eisenhower Medical Center 462 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mission Home Health Palm Desert Home health agency, Palm Desert, CA, CCN 059695
• Eisenhower Medical Center Hospital, Rancho Mirage, CA, CCN 050573

Merit-based Incentive Payment System (MIPS)

Final score

87.87 of 100Reported as group

Quality

85.37

Promoting interoperability

100

Improvement activities

40

Cost

74.18

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1962963447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR STE 205",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704150",
            "telephone_number": "760-834-3540",
            "fax_number": "760-834-3590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR STE 205",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704150",
            "telephone_number": "760-834-3540",
            "fax_number": "760-834-3590"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39000 Bob Hope Dr",
            "address_purpose": "LOCATION",
            "city": "Rancho Mirage",
            "state": "CA",
            "postal_code": "922703221",
            "country_code": "US",
            "telephone_number": "760-834-7997",
            "fax_number": "760-837-8928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUKRY",
        "first_name": "JENAN",
        "middle_name": "NADIM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "125.074930",
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "IL",
            "license": "036165201",
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "CA",
            "license": "A198119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Shin, DDS
• Jared C. Shipley, PA-C
• Barbara S. Shore, PH.D., MFT
• Peter Charles Shorts, LCSW
• Scott A Shuford, NP
• Elizabeth Siacunco, MD
• Nicole Siacunco, DO
• Koushan Siami-Namini, MD
• Sierra Psychological Associates, Inc.
• Sepehr Silani, MD

• All providers in Rancho Mirage, CA
• Vascular Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; 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.