Individual provider Active NPI

Melissa Anne Maxwell, PMHNP - BC

  • Psychiatric/Mental Health Nurse Practitioner
  • San Francisco, CA
National Provider Identifier
1518502319
Registry record updated Nov 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
71009757B Issued in IN
Practice address
490 Post St Ste 1043
San Francisco, CA 94102-1301
Phone
(925) 282-1778
Fax
(415) 296-5299
NPI assigned
Nov 15, 2019
Last updated
Nov 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 28200431A IN
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95013526 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 71009757B IN Primary

Addresses

Primary practice location

490 Post St Ste 1043
San Francisco, CA 94102-1301

Mailing address

490 Post St Ste 1043
San Francisco, CA 94102-1301
Phone (925) 282-1778

Other practice location 1

7300 E Indiana St
Evansville, IN 47715-7448
Phone (812) 401-8008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200221001208 IN Practitioner - Nurse Practitioner 7517394083 Reassigns benefits to 2 organizations
I20240816001705 CA Practitioner - Nurse Practitioner 7517394083 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians
Midwest Behavioral Health LLCGroup PAC ID 4587834874, 132 clinicians

Practice addresses (Care Compare)

2365 Iron Point Rd
Suite 210
Folsom, CA 95630-8713
Phone (925) 282-1778

7300 E Indiana St
Suite 103
Evansville, IN 47715-7448
Phone (812) 401-8008

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28200431AINMDNurse Practitioner
71009757BINMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Psychiatric Associates Inc CurrentSince Jul 5, 2024 Accepting new patients
Midwest Behavioral Health LLC CurrentSince Jun 1, 2020 Accepting new patients
Brentwood Meadows Physician Group LLC Psychiatric/Mental Health CurrentSince Feb 9, 2020 Accepting new patients

Locations

1480 64th St
Ste 150
Emeryville, CA 94608
Phone (415) 296-5292

2365 Iron Point Rd
Ste 210
Folsom, CA 95630
Phone (925) 360-5264

490 Post St
Ste 1043
San Francisco, CA 94102
Phone (415) 409-0944

7300 E Indiana St
Ste 103
Evansville, IN 47715
Phone (812) 401-8008

10967 Allisonville Rd
Ste 240
Fishers, IN 46038
Phone (317) 436-1222

4488 Roslin Rd
Newburgh, IN 47630
Phone (812) 710-4038

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.melissamaxwell@148377.advancedmd-direct.com
  • Direct secure messaging: mbh.melissamaxwell@140099.advancedmd-direct.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730592000000",
    "number": "1518502319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 POST ST STE 1043",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941021301",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 POST ST STE 1043",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941021301",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7300 E Indiana St",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477157448",
            "country_code": "US",
            "telephone_number": "812-401-8008",
            "fax_number": "812-401-8201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "MELISSA",
        "middle_name": "ANNE",
        "credential": "PMHNP - BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-15",
        "last_updated": "2024-11-03",
        "certification_date": "2024-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "28200431A",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95013526",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71009757B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.