Individual provider Active NPI

Noah Kojo Peter

  • Psychiatric/Mental Health Nurse Practitioner
  • Culver City, CA
National Provider Identifier
1043927684
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
9518936 Issued in CA
Practice address
3828 Delmas Ter
Culver City, CA 90232-2713
Phone
(310) 836-7000
NPI assigned
Nov 2, 2022
Last updated
Nov 2, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 9518936 CA Primary

Addresses

Primary practice location

3828 Delmas Ter
Culver City, CA 90232-2713

Mailing address

3828 Delmas Ter
Culver City, CA 90232-2713
Phone (310) 836-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230119001634 CA Practitioner - Nurse Practitioner 7911378476 Reassigns benefits to 2 organizations
I20240903000706 NV Practitioner - Nurse Practitioner 7911378476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12611 Artesia Blvd
Apt 119
Cerritos, CA 90703-8680
Phone (323) 568-9184

7455 Arroyo Crossing Pkwy
Suite 220
Las Vegas, NV 89113-4088
Phone (323) 568-9184

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9518936CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mentally Healthy LLC Psychiatric/Mental Health CurrentSince Oct 18, 2023 Accepting new patients
Teletherapeutics Health Ca Corp CurrentSince Nov 1, 2022 Accepting new patients

Locations

18520 Pioneer Blvd
Ste 203
Artesia, CA 90701

18520 Pioneer Blvd
Ste 205
Artesia, CA 90701

710 Rimpau Ave
Ste 102
Corona, CA 92879
Phone (213) 373-5523

26498 Baseline St
Ste A
Highland, CA 92346

7455 Arroyo Crossing Pkwy
Ste 220
Las Vegas, NV 89113
Phone (702) 761-6467

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1043927684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3828 DELMAS TER",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322713",
            "telephone_number": "310-836-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3828 DELMAS TER",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322713",
            "telephone_number": "310-836-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETER",
        "first_name": "NOAH",
        "middle_name": "KOJO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-02",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "9518936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

Verify at the official NPI Registry.