Active NPI
Nathaniel Mark Pedley, MD
- Internal Medicine Physician
- Los Angeles, CA
National Provider Identifier
1669978532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 164594
- Practice address
- 757 Westwood PLZ Ste 7501
Los Angeles, CA 90095-8358 - Phone
- (310) 825-7375
- NPI assigned
- Apr 1, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 164594 | CA | Primary |
Addresses
Primary practice location
757 Westwood PLZ Ste 7501
Los Angeles, CA 90095-8358
Mailing address
757 Westwood PLZ Ste 7501
Los Angeles, CA 90095-8358
Phone (310) 825-7375
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Aug 25, 2025 through Aug 25, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164594 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Form Health Associates, P.C. | Past | Accepting new patients |
Interoperability endpoints
- nathaniel.pedley@168064768409604.direct.elationemr.com
- nathaniel.pedley@398599422017540.direct.elationemr.com
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.
-
- Endocrinology, Diabetes & Metabolism Physician
- Bakersfield, CA
- NPI 1801615752
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595116800000",
"number": "1669978532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "757 WESTWOOD PLZ STE 7501",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900958358",
"telephone_number": "310-825-7375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "757 WESTWOOD PLZ STE 7501",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900958358",
"telephone_number": "310-825-7375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDLEY",
"first_name": "NATHANIEL",
"middle_name": "MARK",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-01",
"last_updated": "2020-07-19",
"certification_date": "2020-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "164594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.