Individual provider Active NPI

Anthony Bao Pham

  • Psychiatric/Mental Health Nurse Practitioner
  • Anaheim, CA
National Provider Identifier
1629796438
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95021385 Issued in CA
Practice address
421 N Brookhurst St Ste 119
Anaheim, CA 92801-5618
Phone
(714) 361-0898
NPI assigned
Aug 17, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95021385 CA Primary

Addresses

Primary practice location

421 N Brookhurst St Ste 119
Anaheim, CA 92801-5618

Mailing address

421 N Brookhurst St Ste 119
Anaheim, CA 92801-5618

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
I20230227002268 CA Practitioner - Nurse Practitioner 8426421280 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mental Health and Nursing PCGroup PAC ID 5294151635, 10 clinicians

Practice addresses (Care Compare)

421 N Brookhurst St
Suite 119
Anaheim, CA 92801-5618
Phone (714) 361-0898

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health and Nursing PC Psychiatric/Mental Health CurrentSince Dec 1, 2022 Accepting new patients
Renewed Medical Group, a Professional Medical Corporation Psychiatric/Mental Health CurrentSince Jun 5, 2024 Accepting new patients

Locations

421 N Brookhurst St
Ste 119
Anaheim, CA 92801
Phone (714) 253-6570

3780 Kilroy Airport Way
Ste 200
Long Beach, CA 90806
Phone (323) 548-8820

4276 Katella Ave
Los Alamitos, CA 90720

1131 W 6th St
Ste 232
Ontario, CA 91762
Phone (714) 361-0898

202 Fashion Ln
Ste 102
Tustin, CA 92780
Phone (714) 361-0898

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1660694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1629796438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 N BROOKHURST ST STE 119",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928015618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 N BROOKHURST ST STE 119",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928015618",
            "telephone_number": "714-361-0898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "ANTHONY",
        "middle_name": "BAO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-17",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95021385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.