Individual provider Active NPI

Robert Jimenez, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1497155360
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95011085 Issued in CA
Practice address
1625 Schrader Blvd
Los Angeles, CA 90028-6213
Phone
(323) 993-7500
Fax
(323) 308-4456
NPI assigned
Aug 28, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 831722 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95011085 CA Primary

Addresses

Primary practice location

1625 Schrader Blvd
Los Angeles, CA 90028-6213

Mailing address

1625 Schrader Blvd
Los Angeles, CA 90028-6213

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200409001116 CA Practitioner - Nurse Practitioner 6406285667 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Los Angeles LGBT CenterGroup PAC ID 8729975453, 29 clinicians

Practice addresses (Care Compare)

1625 Schrader Blvd
FL 3
Los Angeles, CA 90028-6213
Phone (323) 993-7400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
831722CAMDRegistered Nurse
95011085CAMDPsychiatric/Mental Health Nurse Practitioner

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1409184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1497155360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 SCHRADER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900286213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SCHRADER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900286213",
            "telephone_number": "323-993-7500",
            "fax_number": "323-308-4456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "ROBERT",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-28",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "831722",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95011085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.