NPIMap

Organization Active NPI

Pioneer Pediatrics Wellness Center

  • Pediatrics Physician
  • Las Vegas, NV
National Provider Identifier
1124910179
Registry record updated Nov 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PIONEER PEDIATRICS WELLNESS CENTER
Practice address
3210 W Charleston Blvd Ste 2
Las Vegas, NV 89102-0080
Phone
(702) 370-7842
NPI assigned
Jul 16, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2025

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

Authorized official

Name
Priscilla Otoo-Adjorlolo, LCSWNPI 1780887463
Title
Director
Phone
(702) 370-7842

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatric Neurodevelopmental Disabilities PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0008X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

3210 W Charleston Blvd Ste 2
Las Vegas, NV 89102-0080

Mailing address

3210 W Charleston Blvd Ste 2
Las Vegas, NV 89102-0080
Phone (702) 370-7842

Other practice location 1

4840 E Bonanza Rd Ste 5
Las Vegas, NV 89110-3453
Phone (702) 370-7842 ext. 07842

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251017000947 NV Part B Supplier - Clinic/Group Practice 8224525639 Receives reassigned benefits from 3 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory
Tax ID family
Pioneer Pediatrics Wellness Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764460800000",
    "number": "1124910179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 W CHARLESTON BLVD STE 2",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891020080",
            "telephone_number": "702-370-7842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 W CHARLESTON BLVD STE 2",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891020080",
            "telephone_number": "702-370-7842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4840 E Bonanza Rd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891103453",
            "country_code": "US",
            "telephone_number": "702-370-7842 x07842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PIONEER PEDIATRICS WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-11-30",
        "certification_date": "2025-11-30",
        "status": "A",
        "authorized_official_last_name": "OTOO-ADJORLOLO",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "702-370-7842",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.