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SHAFA MEDICAL CLINIC PC
NPI 1194906925
Clinic/Center in Phoenix, AZ

Active since November 20, 2007CLIA 03D0969533 · Waiver
202 E EARLL DR STE 150, PHOENIX, AZ 85012(602) 248-8258(602) 248-8259 Get Directions Write a Review

NPPES record last updated: November 20, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Shafa Medical Clinic Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHAFA MEDICAL CLINIC PC (NPI 1194906925) is a healthcare organization registered as a clinic/center in Phoenix, Arizona and active in the NPI registry since November 2007. The organization holds a CLIA Waiver certificate valid through January 18, 2028 and lists Amanda Modesta, Medical Director /president, as its authorized official.

NPPES Registry Identity

NPI1194906925
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameSHAFA MEDICAL CLINIC PC
Location Address202 E EARLL DR STE 150Phoenix, AZ 85012-2636
Mailing Address202 E Earll Dr Ste 150Phoenix, AZ 85012-2636 · (602) 248-8258 · Fax (602) 248-8259
Phone(602) 248-8258
Fax(602) 248-8259
Organization SubpartNo
Authorized OfficialAmanda ModestaMedical Director /president · (602) 248-8258
Enumeration DateNovember 20, 2007
✔ NPI 1194906925 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in AZ · 07569335N
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
202 E EARLL DR STE 150, Phoenix, AZ 85012
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Other Identifiers 3

OtherAZ0860140AZ · Bc/bs
Medicaid447921AZ
Medicare PINZ64150AZ

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shafa Medical Clinic Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Shafa Medical Clinic PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Amanda Modesta Keyhani, MD
Internal Medicine
NPI 1316993371
202 E EARLL DRIVE #150
Phoenix, AZ 85012
(602) 248-8258
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D0969533

Shafa Medical Clinic · Phoenix, AZ
Active · expires Jan 18, 2028
CLIA Number03D0969533
Laboratory TypePhysician Office
Certificate Effective DateJanuary 19, 2026
Certificate Expiration DateJanuary 18, 2028
Laboratory DirectorAmanda Modesta Keyhani MD
Laboratory Phone(602) 248-8258
Laboratory LocationShafa Medical Clinic202 E Earll Dr Ste 150, Phoenix, AZ 85012
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shafa Medical Clinic PC's NPI number?

The NPI number for Shafa Medical Clinic PC is 1194906925. It was assigned to this organization in the NPPES registry on November 20, 2007.

Where is Shafa Medical Clinic PC located?

Shafa Medical Clinic PC is located at 202 E Earll Dr Ste 150, Phoenix, AZ 85012. The listed phone number is (602) 248-8258.

What is Shafa Medical Clinic PC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is Shafa Medical Clinic PC enrolled in Medicare?

Yes. Shafa Medical Clinic PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shafa Medical Clinic PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Shafa Medical Clinic PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Shafa Medical Clinic PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D0969533) is associated with this NPI, valid through January 18, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shafa Medical Clinic PC was last updated on November 20, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.