Individual provider Active NPI

Maurice Weise, MD

  • Psychiatry Physician
  • Los Angeles, CA
National Provider Identifier
1043417264
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
G28604 Issued in CA
Practice address
12021 Wilmington Ave
Los Angeles, CA 90059-3019
Phone
(323) 242-5000
NPI assigned
Jun 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X G28604 CA Primary

Addresses

Primary practice location

12021 Wilmington Ave
Los Angeles, CA 90059-3019

Mailing address

12021 Wilmington Ave
Los Angeles, CA 90059-3019
Phone (323) 242-5000

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120229000102 CA Practitioner - Psychiatry 7113185794 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Department of State Hospitals CurrentSince Nov 6, 2021 Accepting new patients
Department of State Hospitals Current Accepting new patients
Shields for Families CurrentSince Mar 22, 2023 Accepting new patients
Department of State Hospitals CurrentSince Nov 6, 2021 Accepting new patients
Los Angeles County Department of Public Health Current Accepting new patients
Amanecer Community Counseling Service, a Non-Profit Corporation PastSince Nov 19, 2012 Accepting new patients

Locations

11601 S Western Ave
Los Angeles, CA 90047
Phone (800) 676-9870

3102 E Highland Ave
Patton, CA 92369
Phone (909) 425-7000

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

Interoperability endpoints

  • Direct secure messaging: mauriceweise-shieldsforfamilies@lacsapc.netsmartdirect.net

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1043417264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12021 WILMINGTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593019",
            "telephone_number": "323-242-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12021 WILMINGTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593019",
            "telephone_number": "323-242-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISE",
        "first_name": "MAURICE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G28604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.