Individual provider Active NPI

Nima Nouri, PSY.D.

  • Clinical Psychologist
  • Beverly Hills, CA
National Provider Identifier
1639308117
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY27239 Issued in CA
Practice address
420 S Beverly Dr Ste 100-9
Beverly Hills, CA 90212-4426
Phone
(213) 223-7264
Fax
(310) 881-8628
NPI assigned
Jul 6, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Psychologist 103TC0700X PSY27239 CA Primary
Rehabilitation Counselor 225C00000X

Addresses

Primary practice location

420 S Beverly Dr Ste 100-9
Beverly Hills, CA 90212-4426

Mailing address

420 S Beverly Dr Ste 100-9
Beverly Hills, CA 90212-4426
Phone (213) 223-7264

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
I20161020000132 CA Practitioner - Clinical Psychologist 0941598239 Reassigns benefits to 1 organization
Practice locations: Beverly Hills, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

420 S Beverly Dr
Suite 100 9
Beverly Hills, CA 90212-4411
Phone (213) 223-7264

420 S Beverly Dr
Suite 100 9
Beverly Hills, CA 90212-4426

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY27239CAMDClinical Psychologist
27239CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mellow Medical Inc a Professional Corporation CurrentSince Feb 1, 2018 Accepting new patients
Darrell Broaddus Psychological Services PC Clinical Past Accepting new patients

Locations

12301 Wilshire Blvd
Ste 512
Los Angeles, CA 90025
Phone (833) 427-3566

8235 Santa Monica Blvd
Ste 302
West Hollywood, CA 90046
Phone (310) 892-4284

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4

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": "1246838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1639308117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S BEVERLY DR STE 100-9",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902124426",
            "telephone_number": "213-223-7264",
            "fax_number": "310-881-8628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S BEVERLY DR STE 100-9",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902124426",
            "telephone_number": "213-223-7264",
            "fax_number": "310-881-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOURI",
        "first_name": "NIMA",
        "name_prefix": "Mr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-06",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY27239",
            "primary": true
        },
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

Verify at the official NPI Registry.