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SHADELANDS ENDOVASCULAR, LLC
NPI 1245620954
Clinic/Center - Ambulatory Surgical in Walnut Creek, CA

Active since February 02, 2015CLIA 05D2116202 · Waiver
460 N WIGET LN STE B, WALNUT CREEK, CA 94598(925) 627-3495(925) 891-4322 Get Directions Write a Review

NPPES record last updated: April 4, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Shadelands Endovascular, Llc NPPES

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

SHADELANDS ENDOVASCULAR, LLC (NPI 1245620954) is a healthcare organization registered as an ambulatory surgical in Walnut Creek, California and active in the NPI registry since February 2015. The organization holds a CLIA Waiver certificate valid through July 20, 2028 and lists Inez Wondeh, Coo, as its authorized official.

NPPES Registry Identity

NPI1245620954
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameSHADELANDS ENDOVASCULAR, LLC
Location Address460 N WIGET LN STE BWalnut Creek, CA 94598-2408
Mailing Address460 N Wiget Ln Ste BWalnut Creek, CA 94598-2408 · (925) 627-3495 · Fax (925) 891-4322
Phone(925) 627-3495
Fax(925) 891-4322
Organization SubpartNo
Authorized OfficialInez WondehCoo · (925) 378-4500
Enumeration DateFebruary 2, 2015
Last NPPES UpdateApril 4, 2018
✔ NPI 1245620954 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
460 N WIGET LN STE B, Walnut Creek, CA 94598
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shadelands Endovascular, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Shadelands Endovascular, LLC, which bills Medicare for the services they deliver. Of these, 4 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Brian Keyashian, M.D.
Vascular Surgery
NPI 1962776245
2637 SHADELANDS DR STE A
Walnut Creek, CA 94598
(925) 932-6330
✔ PECOS✔ Accepts Medicare0.4 mi
Rajiv Nagesetty, MD
Vascular Surgery
NPI 1689786840
2637 SHADELANDS DR
Walnut Creek, CA 94598
(925) 932-6330
✔ PECOS✔ Accepts Medicare0.4 mi
Gonzalo Obnial, M.D.
Vascular Surgery
NPI 1497909931
2637 SHADELANDS DR
Walnut Creek, CA 94598
(925) 932-6330
✔ PECOS✔ Accepts Medicare0.4 mi
Fernando Otero, MD
Vascular Surgery
NPI 1346244183
2637 SHADELANDS DR
Walnut Creek, CA 94598
(925) 932-6330
✔ PECOS0.4 mi
John Bry, MD
Vascular Surgery
NPI 1972614238
350 30TH ST STE 210
Oakland, CA 94609
(510) 832-6131
✔ PECOS15 mi
Valy Boulom, M.D.
Vascular Surgery
NPI 1174785232
18525 SUTTER BLVD STE 140
Morgan Hill, CA 95037
(408) 333-9580
✔ PECOS✔ Accepts Medicare57 mi

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 05D2116202

Shadelands Endovascular, LLC · Walnut Creek, CA
Active · expires Jul 20, 2028
CLIA Number05D2116202
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateJuly 21, 2026
Certificate Expiration DateJuly 20, 2028
Laboratory DirectorFernando Otero, MD
Laboratory Phone(925) 627-3494
Laboratory LocationShadelands Endovascular, LLC460 N Wiget Ln Ste B, Walnut Creek, CA 94598
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 10

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of plaque in artery of leg, initial vessel 37229
This procedure involves removing plaque from the initial vessel in your leg. Plaque, a build-up of fat, cholesterol, and other substances, can block blood flow. The removal process, known as an angioplasty, restores healthy blood circulation in your leg.
203 services144 patients
Removal of plaque in arteries of leg 37225
This procedure, known as atherectomy, involves clearing out plaque buildup in the leg arteries. Plaque can restrict blood flow, causing discomfort and potential health issues. A special device is inserted into the artery to carefully remove the plaque, improving blood circulation.
196 services152 patients
Insertion of needle and/or tube into hemodialysis circuit and balloon dilation of dialysis segment with review by radiologist 36902
This procedure involves inserting a needle or tube into your hemodialysis circuit, a system that cleans your blood when your kidneys can't. A balloon is then used to widen a narrow section of this circuit. A radiologist reviews the procedure to ensure accuracy.
194 services153 patients
Removal of plaque and insertion of stents in arteries of leg 37227
This procedure, known as angioplasty, involves a small tube being inserted into your leg artery. The tube has a tiny balloon that inflates to remove plaque blocking the artery. A stent (a small mesh tube) is then placed to keep the artery open, improving blood flow.
158 services124 patients
Catheter removal of plaque from groin artery, accessed through the skin or open procedure including radiological supervision and interpretation 0238T
This procedure involves the insertion of a thin tube, or catheter, into the artery in your groin. The catheter is used to remove plaque, a substance that can block blood flow. It's performed under radiological supervision for precision. This can be done through a small skin puncture or a more open approach.
43 services31 patients
Insertion of stent in groin artery, initial vessel 37221
A stent is a small, mesh tube that's used to treat narrow or weak arteries. In this procedure, a stent is placed in your groin artery to help keep it open and improve blood flow. It's inserted through a small incision and guided to the problem area.
35 services27 patients

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 Shadelands Endovascular, LLC's NPI number?

The NPI number for Shadelands Endovascular, LLC is 1245620954. It was assigned to this organization in the NPPES registry on February 2, 2015.

Where is Shadelands Endovascular, LLC located?

Shadelands Endovascular, LLC is located at 460 N Wiget Ln Ste B, Walnut Creek, CA 94598. The listed phone number is (925) 627-3495.

What is Shadelands Endovascular, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Is Shadelands Endovascular, LLC enrolled in Medicare?

Yes. Shadelands Endovascular, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shadelands Endovascular, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians, all in Vascular Surgery, reassign their Medicare billing to Shadelands Endovascular, LLC. 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. Of these, 4 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Shadelands Endovascular, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2116202) is associated with this NPI, valid through July 20, 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 Shadelands Endovascular, LLC was last updated on April 4, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.