SHELLEY J PARK (N.P.) – Nurse Practitioner, NPI 1386683480
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
16,353 NURSE PRACTITIONER in CA
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Provider Addresses for SHELLEY J PARK (N.P.)
PO BOX 35380
LAS VEGAS, NV 891335380
Phone: (702) 579-3203
Type: Mailing
PO BOX 10069
SAN BERNARDINO, CA 924230069
Phone: (909) 335-4188
Fax: (909) 796-4158
Type: Mailing
2, West Fern Avenue, Redlands, San Bernardino County, California, 92373, United States
REDLANDS, CA 923735916
Phone: (909) 793-3311
Fax: (909) 796-4158
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $13.
Total Amount is formed as General ($13) + Research ($0) + Ownership ($0) = $13.
Last reported payment date: 2023-07-19 • Largest payer in this snapshot: Boston Scientific Corporation ($13).
Total Amount
$13
General + Research + Ownership
Payments
1
Total payment records
General Amount
$13
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-07-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Boston Scientific Corporation | $13 |
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: 2005-08-25
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050825001070 | I | Nurse Practitioner | CA | TBD |
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.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 97 | 81 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 66 | 66 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 24 | 23 | $0 |
Insurance plans in this area (ZIP 89133)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | CA | |
| - | CA | |
| U R O L O G Y | CA | |
| O P T O M E T R Y | CA | |
| - | CA | |
| - | CA | |
| - | CA | |
| Nurse Practitioner | CA | |
| - | CA | |
| - | CA |
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