Individual provider Active NPI

Kasturi Banerjee, PHD

  • Psychologist
  • Los Angeles, CA
National Provider Identifier
1457189730
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
35184 Issued in CA
Practice address
100 Medical Plaza
Suite 205
Los Angeles, CA 90024
Phone
(310) 825-1597
NPI assigned
Jul 26, 2024
Last updated
Nov 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 35184 CA Primary
Gastroenterology Physician 207RG0100X 35184 CA

Addresses

Primary practice location

100 Medical Plaza
Suite 205
Los Angeles, CA 90024

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (310) 301-8707

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240912003106 CA Practitioner - Clinical Psychologist 5597205831 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Medical Plaza
Los Angeles, CA 90095-0001

100 Medical PLZ
Suite 310
Los Angeles, CA 90095-0001
Phone (310) 825-7922

200 Medical Plaza
Los Angeles, CA 90095-0001

200 Medical PLZ
Los Angeles, CA 90095-0001

200 UCLA Medical PLZ
Suite 165 34
Los Angeles, CA 90095-0001
Phone (310) 824-8403

2020 Santa Monica Blvd
Suite 210
Santa Monica, CA 90404-2139
Phone (310) 458-2381

900 Weyburn Place
Suite 14 171
Los Angeles, CA 90095-0001
Phone (310) 825-8173

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35184CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
The Regents of the University of California Gastroenterology CurrentSince Nov 1, 2024 Accepting new patients
The Regents of the University of California CurrentSince Nov 1, 2024 Accepting new patients

Locations

24302 Paseo de Valencia
Ste 200
Laguna Hills, CA 92653
Phone (949) 458-8252

100 UCLA Medical Plz
Ste 205
Los Angeles, CA 90024
Phone (310) 208-5400

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

File 55737
Los Angeles, CA 90074

892 Aerovista Pl
Ste 240
San Luis Obispo, CA 93401
Phone (805) 541-8252

2020 Santa Monica Blvd
Ste 210
Santa Monica, CA 90404
Phone (310) 458-2381

100 Moody Ct
Ste 200
Thousand Oaks, CA 91360
Phone (805) 418-3500

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": "1721952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1457189730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631",
            "telephone_number": "310-301-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PLAZA",
            "address_2": "SUITE 205",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90024",
            "telephone_number": "310-825-1597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANERJEE",
        "first_name": "KASTURI",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-26",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "35184",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "35184",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.