Individual provider Active NPI

Alan Philip Shahtaji, D.O.

  • Family Medicine Physician
  • San Diego, CA
National Provider Identifier
1972751089
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A11087 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(858) 657-8600
NPI assigned
Sep 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 20A11087 CA
Family Medicine Physician 207Q00000X 20A11087 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20121120000357 CA Practitioner - Family PracticePractitioner - Sports Medicine 7517118623 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centro de Salud de la Comunidad de San Ysidro,Inc.Group PAC ID 6901709435, 291 clinicians
Regents of the University of CaliforniaGroup PAC ID 3577476761, 2,047 clinicians

Practice addresses (Care Compare)

1637 3Rd Ave
Suite B
Chula Vista, CA 91911-5823
Phone (619) 662-4100

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 657-7000

678 3Rd Ave
Chula Vista, CA 91910-5736
Phone (619) 662-4100

9333 Genesee Ave
San Diego, CA 92121-2111
Phone (800) 926-8273

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Family Medicine CurrentSince Sep 30, 2012 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Dec 23, 2012 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Regents of the University of California CurrentSince Sep 30, 2012 Accepting new patients
Scripps Health Past Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

678 Third Ave
Chula Vista, CA 91910
Phone (619) 205-6349

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

4520 Executive Dr
San Diego, CA 92121
Phone (858) 249-1429

9333 Genesee Ave
Ste 200
San Diego, CA 92121
Phone (858) 657-8525

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

9333 Genesee Ave
San Diego, CA 92121
Phone (619) 455-9100

4520 Executive Dr
Ste 1
San Diego, CA 92121

4004 Beyer Blvd
San Ysidro, CA 92173
Phone (619) 428-1330

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: ashahtaji18650@syhealth.direct-ci.com

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1972751089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "858-657-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHTAJI",
        "first_name": "ALAN",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CA",
            "license": "20A11087",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A11087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.