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NI KETUT SUPIYATI
NPI 1023497443
Nurse Practitioner in Huntington Park, CA

Active since May 19, 2015PECOS Enrolled
2638 E FLORENCE AVE, HUNTINGTON PARK, CA 90255(323) 581-4665(323) 581-0551 Get Directions Write a Review

NPPES record last updated: May 19, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ni Ketut Supiyati NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NI KETUT SUPIYATI (NPI 1023497443) is an individual nurse practitioner in Huntington Park, California, licensed in California (NP95001498) and active in the NPI registry since May 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1023497443
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameNI KETUT SUPIYATI
Location Address2638 E FLORENCE AVEHuntington Park, CA 90255-4708
Mailing Address2638 E Florence AveHuntington Park, CA 90255-4708 · (323) 581-4665 · Fax (323) 581-0551
Phone(323) 581-4665
Fax(323) 581-0551
Sole ProprietorYes
Enumeration DateMay 19, 2015
✔ NPI 1023497443 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in CA · NP95001498
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
2638 E FLORENCE AVE, Huntington Park, CA 90255
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Other Identifiers 1

Medicaid95001498CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ni Ketut Supiyati is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90255 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
99%532 patients5/55-star benchmark: 99%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROMA AHMED NP
Doula
2638 E FLORENCE AVE
HUNTINGTON PARK, CA 90255
Los Angeles County (323) 581-4665
DR. SEPEHR KATIRAIE M.D.
Family Medicine
2638 E FLORENCE AVE
HUNTINGTON PARK, CA 90255
Los Angeles County (323) 588-3800
MAYRA SHIRLEY PONCE FNP
Nurse Practitioner (Family)
2638 E FLORENCE AVE
HUNTINGTON PARK, CA 90255
Los Angeles County (323) 588-3800
LYNWOOD MEDICAL IMAGING LLC
Radiology (Diagnostic Radiology)
2638 E FLORENCE AVE
WALNUT PARK, CA 90255
Los Angeles County (323) 588-3800
SEPEHR KATIRAIE MD INC.
Clinic/Center (Primary Care)
2638 E FLORENCE AVE
HUNTINGTON PARK, CA 90255
Los Angeles County (323) 588-3800
SEP COMMUNITY CLINIC
Clinic/Center (Community Health)
2638 E FLORENCE AVE
WALNUT PARK, CA 90255
Los Angeles County (323) 588-3800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ni Ketut Supiyati's NPI number?

The NPI number for Ni Ketut Supiyati is 1023497443. It was assigned to this individual provider in the NPPES registry on May 19, 2015.

Where is Ni Ketut Supiyati located?

Ni Ketut Supiyati practices at 2638 E Florence Ave, Huntington Park, CA 90255. The listed phone number is (323) 581-4665.

What is Ni Ketut Supiyati's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Ni Ketut Supiyati enrolled in Medicare?

Yes. Ni Ketut Supiyati is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ni Ketut Supiyati was last updated on May 19, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.