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DR. NICOLE JOHNISE SHAW MD
NPI 1780315473
Family Medicine in South Gate, CA

Active since June 22, 2022PECOS Enrolled
4476 TWEEDY BLVD STE B, SOUTH GATE, CA 90280(323) 825-8300(866) 372-2719 Get Directions Write a Review

NPPES record last updated: June 10, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Nicole Johnise Shaw Md NPPES

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

DR. NICOLE JOHNISE SHAW MD (NPI 1780315473) is an individual family medicine provider in South Gate, California, licensed in California (A204378) and active in the NPI registry since June 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1780315473
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameDR. NICOLE JOHNISE SHAWCredential: MD
Location Address4476 TWEEDY BLVD STE BSouth Gate, CA 90280-6359
Mailing Address4476 Tweedy Blvd Ste BSouth Gate, CA 90280-6359 · (323) 825-8300 · Fax (323) 268-9119
Phone(323) 825-8300
Fax(866) 372-2719
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateJune 22, 2022
Last NPPES UpdateJune 10, 2026
NPPES CertifiedJune 10, 2026
✔ NPI 1780315473 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CA · A204378
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4476 TWEEDY BLVD STE B, South Gate, CA 90280
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Nicole Johnise Shaw Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4688151475
PECOS Enrollment IDI20260122003855
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.

Medicare Billing Reassignment

Medicare enrollment records show Nicole Shaw reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Via Care Community Health Center
6.1 mi
Federally Qualified Health Center (FQHC)
607 S ATLANTIC BLVD
Los Angeles, CA 90022
  • Reassigned Medicare billing, California enrollment
  • 45 clinicians in this Medicare group
NPI 1770034530 (323) 268-9191

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90280 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 8

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

DIAMOND BLAIR NP
Nurse Practitioner (Family)
4476 TWEEDY BLVD STE B
SOUTH GATE, CA 90280
Los Angeles County (323) 268-9191
VIA CARE COMMUNITY HEALTH CENTER
Pharmacy
4476 TWEEDY BLVD STE B
SOUTH GATE, CA 90280
Los Angeles County (323) 268-9191
MAYRA JUDITH FIGUEROA
Licensed Vocational Nurse
4476 TWEEDY BLVD STE B
SOUTH GATE, CA 90280
Los Angeles County (323) 825-8300
JONATHAN LIM DO
Pediatrics
4476 TWEEDY BLVD STE B
SOUTH GATE, CA 90280
Los Angeles County (323) 825-8300
BRIANNA WOO N.
Nurse Practitioner (Family)
4476 TWEEDY BLVD STE B
SOUTH GATE, CA 90280
Los Angeles County (323) 268-9191
MUKUL AERI FNP-C
Nurse Practitioner
4476 TWEEDY BLVD STE B
SOUTH GATE, CA 90280
Los Angeles County (323) 268-9191
MARIA EUGENIA MANCERA LVN
Licensed Vocational Nurse
4476 TWEEDY BLVD STE B
SOUTH GATE, CA 90280
Los Angeles County (323) 825-8300
VIA CARE COMMUNITY HEALTH CENTER
Clinic/Center (Federally Qualified Health Center (FQHC))
4476 TWEEDY BLVD STE B
SOUTH GATE, CA 90280
Los Angeles County (323) 268-9191

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 Nicole Shaw's NPI number?

The NPI number for Nicole Shaw is 1780315473. It was assigned to this individual provider in the NPPES registry on June 22, 2022.

Where is Nicole Shaw located?

Nicole Shaw practices at 4476 Tweedy Blvd Ste B, South Gate, CA 90280. The listed phone number is (323) 825-8300.

What is Nicole Shaw's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Nicole Shaw enrolled in Medicare?

Yes. Nicole Shaw is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Nicole Shaw's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicole Shaw reassigns Medicare benefits to Via Care Community Health Center (Los Angeles, CA). The 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 Nicole Shaw's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Nicole Shaw was last updated on June 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months 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.