Joseph A Derije, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95005123 Issued in CA

Practice address

9808 Venice Blvd
Suite 700
Culver City, CA 90232-2732

Phone

(310) 945-3350

Fax

(310) 840-7023

NPI assigned

Apr 29, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Exodus Recovery IncGroup PAC ID 2668467341, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FDIHCA/Endpoint/FDIHCA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Exodus Recovery Inc

  • Community/Behavioral Health Agency
  • Los Angeles, CA
  • NPI 1245441906
  Medicare reassignment Care Compare group NPD
• Tarzana Treatment Centers, Inc.

  • Community/Behavioral Health Agency
  • Lancaster, CA
  • NPI 1346842093
  Medicare reassignment NPD
• Exodus Recovery, Inc.

  • Community/Behavioral Health Agency
  • Lynwood, CA
  • NPI 1174300412
  NPD
• Exodus Recovery, Inc.

  • Community/Behavioral Health Agency
  • Los Angeles, CA
  • NPI 1356711436
  NPD
• Tarzana Treatment Centers, Inc.

  • Medical Specialty Clinic/Center
  • Palmdale, CA
  • NPI 1285930396
  NPD
• Tarzana Treatment Centers, Inc.

  • Multi-Specialty Clinic/Center
  • Palmdale, CA
  • NPI 1619702099
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1003107616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9808 VENICE BLVD",
            "address_2": "SUITE 700",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322732",
            "telephone_number": "310-945-3350",
            "fax_number": "310-840-7023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9808 VENICE BLVD",
            "address_2": "SUITE 700",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322732",
            "telephone_number": "310-945-3350",
            "fax_number": "310-840-7023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERIJE",
        "first_name": "JOSEPH",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-29",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "743245",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95005123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sabrina Nicole Desisto
• Anthonia Uche Deso-Ogugua, RN
• Dianne Regina Detomaso
• Nicole Rose Detore
• Development Specialty Projects, Inc.

• Psychiatric/Mental Health Nurse Practitioner in Culver City, CA
• Providers in Culver City, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.