NPIMap

Organization Active NPI

Mental Wellness Partners

  • Psychiatry Physician
  • Upland, CA
National Provider Identifier
1972096295
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
20A12214 Issued in CA
Legal business name
MENTAL WELLNESS PARTNERS
Practice address
820 N Mountain Ave Ste 215
Upland, CA 91786-4163
Phone
(909) 920-3171
NPI assigned
Jun 11, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Authorized official

Name
Mr. Percival John Baldrias, NPNPI 1831399740
Title
Nurse Practitioner/Cfo
Phone
(909) 920-3171

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 20A12214 CA Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0808X NP16510 CA

Addresses

Primary practice location

820 N Mountain Ave Ste 215
Upland, CA 91786-4163

Mailing address

14617 Westfield Ave
Chino, CA 91710-1303
Phone (909) 203-3523

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180921003169 CA Part B Supplier - Clinic/Group Practice 0749531259 Receives reassigned benefits from 12 practitioners
Practice locations: Upland, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1972096295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14617 WESTFIELD AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917101303",
            "telephone_number": "909-203-3523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 N MOUNTAIN AVE STE 215",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864163",
            "telephone_number": "909-920-3171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL WELLNESS PARTNERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-11",
        "last_updated": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "BALDRIAS",
        "authorized_official_first_name": "PERCIVAL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/CFO",
        "authorized_official_telephone_number": "909-920-3171",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A12214",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "NP16510",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.