NPIMap

Individual provider Active NPI

Theresa Anderson, N.P.

  • Adult Health Nurse Practitioner
  • Van Nuys, CA
National Provider Identifier
1295101483
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
NP95002121 Issued in CA
Practice address
13755 Victory Blvd
Van Nuys, CA 91401-2348
Phone
(818) 988-9825
Fax
(818) 988-9305
NPI assigned
Aug 11, 2015
Last updated
Aug 11, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X NP95002121 CA Primary

Addresses

Primary practice location

13755 Victory Blvd
Van Nuys, CA 91401-2348

Mailing address

13755 Victory Blvd
Van Nuys, CA 91401-2348
Phone (818) 988-9825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190122003517 CA Practitioner - Nurse Practitioner 5890032320 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

638 Main St
Ferndale, CA 95536-1157
Phone (707) 786-4028

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP95002121CAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Open Door Community Health Centers Current Accepting new patients
Angel Wings Medical Associates CurrentSince Sep 5, 2018 Accepting new patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers CurrentSince Sep 20, 2021 Accepting new patients
Open Door Community Health Centers CurrentSince Sep 20, 2021 Accepting new patients

Locations

1275 8th St
Arcata, CA 95521

770 10th St
Arcata, CA 95521
Phone (707) 826-8610

785 18th St
Arcata, CA 95521
Phone (707) 822-2481

1130 W Olive Ave
Burbank, CA 91506
Phone (818) 645-5686

550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636

2200 Tydd St
Eureka, CA 95501
Phone (707) 441-1624

1644 Central Ave
McKinleyville, CA 95519
Phone (707) 839-3068

Interoperability endpoints

  • Direct secure messaging: tanderson356788@direct.ochin.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439251200000",
    "number": "1295101483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13755 VICTORY BLVD",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012348",
            "telephone_number": "818-988-9825",
            "fax_number": "818-988-9305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13755 VICTORY BLVD",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012348",
            "telephone_number": "818-988-9825",
            "fax_number": "818-988-9305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "THERESA",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2015-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "NP95002121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

Verify at the official NPI Registry.