Individual provider Active NPI

Jesus Manuel Rivera, PHD

  • Clinical Psychologist
  • Los Angeles, CA
National Provider Identifier
1619726742
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY34945 Issued in CA
Practice address
300 UCLA Medical PLZ Ste 2200
Los Angeles, CA 90095-8353
Phone
(310) 825-9989
Fax
(310) 267-1908
NPI assigned
May 13, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X
Clinical Psychologist 103TC0700X PSY34945 CA Primary

Addresses

Primary practice location

300 UCLA Medical PLZ Ste 2200
Los Angeles, CA 90095-8353

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

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
I20240613003422 CA Practitioner - Clinical Psychologist 0941743389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
UC RegentsGroup PAC ID 0749180453, 148 clinicians

Practice addresses (Care Compare)

300 Medical PLZ
Suite 2200
Los Angeles, CA 90095-6968
Phone (310) 825-9989

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSY34945CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents Clinical CurrentSince Aug 1, 2024 Accepting new patients

Locations

300 Medical Plz
Los Angeles, CA 90095
Phone (310) 206-8438

760 Westwood Plz
#C8832
Los Angeles, CA 90095

760 Westwood Plz
Los Angeles, CA 90095
Phone (310) 829-9989

File 2939
Los Angeles, CA 90074
Phone (310) 794-6596

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

300 UCLA Medical Plz
Ste 2200
Los Angeles, CA 90095
Phone (310) 267-6810

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": "1715558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1619726742",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UCLA MEDICAL PLZ STE 2200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958353",
            "telephone_number": "310-825-9989",
            "fax_number": "310-267-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "JESUS",
        "middle_name": "MANUEL",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY34945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.