JOHNATHAN SHAW
NPI 1558725952
Student in an Organized Health Care Education/Training Program in Fontana, CA

Q: What is Johnathan Shaw's NPI number?

The NPI number for Johnathan Shaw is 1558725952. It was assigned to this individual provider in the NPPES registry on April 12, 2016.

Q: What is Johnathan Shaw's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Johnathan Shaw was last updated on December 8, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since April 12, 2016PECOS EnrolledAccepts Medicare Assignment

9961 SIERRA AVE, FONTANA, CA 92335(909) 427-2608(909) 427-5312 Get Directions Write a Review

NPPES record last updated: December 8, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Johnathan Shaw NPPES

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

JOHNATHAN SHAW (NPI 1558725952) is an individual student in an organized health care education/training program in Fontana, California and active in the NPI registry since April 2016. He is enrolled in Medicare PECOS and is a graduate of Temple University School Of Medicine (2016).

NPPES Registry Identity

NPI1558725952

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameJOHNATHAN SHAW

Location Address9961 SIERRA AVEFontana, CA 92335-6720

Mailing Address17234 Valley BlvdFontana, CA 92335 · (909) 427-2609 · Fax (909) 427-5312

Phone(909) 427-2608

Fax(909) 427-5312

Sole ProprietorNo

Medical School CMSTemple University School Of MedicineGraduated 2016

Enumeration DateApril 12, 2016

Last NPPES UpdateDecember 8, 2021

NPPES CertifiedDecember 8, 2021

✔ NPI 1558725952 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

9961 SIERRA AVE, Fontana, CA 92335

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Johnathan Shaw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3476897794

PECOS Enrollment IDI20181127002430

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHEILA ANN VANALLEN PT

Physical Therapist

9961 SIERRA AVE, BUILDING 3A
FONTANA, CA 92335

San Bernardino County (909) 427-7727

MR. JAMES DAVID KILLEEN III M.D.

Pediatrics

9961 SIERRA AVE, KAISER PERMANENTE FONTANA - PEDIATRICS
FONTANA, CA 92335

San Bernardino County (909) 427-6960

MR. DHIRESH N PATEL RPH

Pharmacist