Individual provider Active NPI

Ellen Thomson Bauersfeld, RD

  • Registered Dietitian
  • Tarzana, CA
National Provider Identifier
1881763472
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
18372 Clark St
Suite 226
Tarzana, CA 91356-3508
Phone
(818) 881-9192
Fax
(818) 881-0261
NPI assigned
Nov 7, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

18372 Clark St
Suite 226
Tarzana, CA 91356-3508

Mailing address

18372 Clark St
Suite 226
Tarzana, CA 91356-3508
Phone (818) 881-9192

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091104000379 CA Practitioner - Registered Dietitian Or Nutrition Professional 7012063233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1987
Medicare assignment
May accept Medicare assignment
Group practices
Medical Nutrition Network LLCGroup PAC ID 1052467263, 2 clinicians

Practice addresses (Care Compare)

18372 Clark St
Suite 228
Tarzana, CA 91356-3555
Phone (818) 881-9192

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Nutrition Network LLC Dietitian, Registered CurrentSince Jun 26, 2009 Accepting new patients

Locations

18372 Clark St
Ste 228
Tarzana, CA 91356
Phone (818) 384-2886

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881763472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18372 CLARK ST",
            "address_2": "SUITE 226",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913563508",
            "telephone_number": "818-881-9192",
            "fax_number": "818-881-0261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18372 CLARK ST",
            "address_2": "SUITE 226",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913563508",
            "telephone_number": "818-881-9192",
            "fax_number": "818-881-0261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUERSFELD",
        "first_name": "ELLEN",
        "middle_name": "THOMSON",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarzana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.