Active NPI
Jody Herman
- Registered Dietitian
- Los Angeles, CA
National Provider Identifier
1184110124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86086412
- Practice address
- 633 W 5TH St
Los Angeles, CA 90071-2005 - Phone
- (310) 663-9726
- NPI assigned
- Jul 2, 2018
- Last updated
- Jul 2, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86086412 | CA | Primary |
Addresses
Primary practice location
633 W 5TH St
Los Angeles, CA 90071-2005
Mailing address
16611 Pequeno PL
Pacific Palisades, CA 90272-2241
Phone (131) 066-3972
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200521001433 | CA | Practitioner - Registered Dietitian Or Nutrition Professional | 9830520121 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86086412 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Dandelion Nutrition LLC | Dietitian, Registered | Past | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 3
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.
-
dba Dandelion Nutrition
- Registered Dietitian
- Lacey, WA
- NPI 1285046292
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530489600000",
"number": "1184110124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16611 PEQUENO PL",
"city": "PACIFIC PALISADES",
"state": "CA",
"postal_code": "902722241",
"telephone_number": "131-066-3972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 W 5TH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900712005",
"telephone_number": "310-663-9726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERMAN",
"first_name": "JODY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-02",
"last_updated": "2018-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86086412",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; 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.