DR. SHIRLEY LYNNE VAN (MD) – Dermatology Physician, NPI 1063530749

DR. SHIRLEY LYNNE VAN (MD) is a healthcare provider. based in Modesto, California. specializing in DERMATOLOGY. They hold the professional credentials MD. They hold a License No. G51607 (CA). The NPI Number for DR. SHIRLEY LYNNE VAN (MD) is 1063530749

Main info

Female
Sole Proprietor
44 Years Of Experience
Accepts Medicare Assignment
Name
DR. SHIRLEY LYNNE VAN (MD)
NPI
1063530749
Phone
(209) 526-2242
Address
1429 COLLEGE AVE
Enumeration Date
27 March 2007
Last Update Date
1 October 2025

Doctor Profile

Medical School Name
UNIVERSITY OF MIAMI, LM MILLER SCHOOL OF MEDICINE
Secondary Phone
-
Graduation Year
1982 (44 years ago)
PAC ID
6507941580
Professional Enrollment ID
I20080314000495
Address ID
CA900455631LO5767XBLVD409
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience62
Completeness85
Years active:19State licenses:1Digital endpointsOther names

2,140 DERMATOLOGY in CA

Provider Addresses for DR. SHIRLEY LYNNE VAN (MD)

  • 1429 COLLEGE AVE

    SUITE B

    MODESTO, CA 953504057

    Phone: (209) 526-2242

    Type: Mailing

  • 862 AEROVISTA PL STE 100

    SAN LUIS OBISPO, CA 934018758

    Phone: (805) 549-8023

    Fax: (805) 549-8252

    Type: Location

  • 26800 Crown Valley Pkwy Ste 435

    Mission Viejo, CA 926918023

    Phone: (949) 573-9510

    Type: Location

  • 5767 W CENTURY BLVD STE 400

    LOS ANGELES, CA 900455631

    Phone:

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 13 Open Payments records for all available years, with a total value of $536.

Total Amount is formed as General ($536) + Research ($0) + Ownership ($0) = $536.

Last reported payment date: 2024-03-11 • Largest payer in this snapshot: ABBVIE INC. ($215).

Total Amount

$536

General + Research + Ownership

Payments

13

Total payment records

General Amount

$536

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-03-11

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-04-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20080314000495IDermatologyCATBD
I20240411002067IDermatologyILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths31657$0
99213Established patient office or other outpatient visit, 20-29 minutes8981$0
17000Destruction of precancer skin growth, 1 growth7366$0
99212Established patient office or other outpatient visit, 10-19 minutes6052$0
17110Destruction of skin growth, 1-14 growths4538$0
View full utilization report →

Insurance plans in this area (ZIP 95350)

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Reviews

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Frequently asked questions

How do I look up DR. SHIRLEY LYNNE VAN (MD) by NPI?
Use NPI 1063530749 when you need to reference DR. SHIRLEY LYNNE VAN (MD) in forms, claims, or directories.
Is DR. SHIRLEY LYNNE VAN (MD) currently active in the NPI registry?
CMS-published data lists DR. SHIRLEY LYNNE VAN (MD) as an active registrant.
What field does DR. SHIRLEY LYNNE VAN (MD) work in?
You can think of DR. SHIRLEY LYNNE VAN (MD) as practicing within Dermatology Physician. Clinical services aligned with this taxonomy classification.
Does DR. SHIRLEY LYNNE VAN (MD) practice in California?
You will see Modesto, California on file for DR. SHIRLEY LYNNE VAN (MD) alongside any extra practice locations.
What if Modesto, California seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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