NOURISHING WELLNESS MEDICAL CENTER
NPI 1164466884
Preventive Medicine - Public Health & General Preventive Medicine in Redondo Beach, CA

Q: What is Nourishing Wellness Medical Center's NPI number?

The NPI number for Nourishing Wellness Medical Center is 1164466884. It was assigned to this organization in the NPPES registry on June 15, 2006.

Q: What is Nourishing Wellness Medical Center's specialty?

The primary specialty registered for this NPI is Preventive Medicine, specializing in Public Health & General Preventive Medicine, with taxonomy code 2083P0901X.

Active since June 15, 2006

819 N HARBOR DR STE 310, REDONDO BEACH, CA 90277(310) 373-7830(310) 373-7830 Get Directions Write a Review

NPPES record last updated: April 20, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Nourishing Wellness Medical Center NPPES

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

NOURISHING WELLNESS MEDICAL CENTER (NPI 1164466884) is a healthcare organization registered as a public health & general preventive medicine in Redondo Beach, California and active in the NPI registry since June 2006. The organization lists Allen Hermann Peters, President/medical Director, as its authorized official.

NPPES Registry Identity

NPI1164466884

Entity TypeOrganization

Primary Taxonomy2083P0901X

Legal Business NameNOURISHING WELLNESS MEDICAL CENTER

Location Address819 N HARBOR DR STE 310Redondo Beach, CA 90277-2056

Mailing Address819 N Harbor Dr Ste 310Redondo Beach, CA 90277-2056 · (310) 373-7830 · Fax (310) 373-7840

Phone(310) 373-7830

Fax(310) 373-7830

Organization SubpartNo

Authorized OfficialAllen Hermann PetersPresident/medical Director · (310) 373-7830

Enumeration DateJune 15, 2006

Last NPPES UpdateApril 20, 2020

NPPES CertifiedApril 20, 2020

✔ NPI 1164466884 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPreventive Medicine · Public Health & General Preventive MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2083P0901X

Definition

Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings.

Also ListedDietitian, Registered · Nutrition, MetabolicTaxonomy 133VN1006X

819 N HARBOR DR STE 310, Redondo Beach, CA 90277

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nourishing Wellness Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by October 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateCaliforniaEnrollment IDO20061011000486Non-DME Part B · Clinic/Group PracticeDue dateOctober 31, 2026

Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Nourishing Wellness Medical Center, which bills Medicare for the services this clinician delivers.

Clinician (1)

Allen Peters, M.D.

Preventive Medicine

NPI 1881608909

819 N HARBOR DR SUITE 310
Redondo Beach, CA 90277

(310) 373-7830

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Nourishing Wellness Medical Center's NPI number?

The NPI number for Nourishing Wellness Medical Center is 1164466884. It was assigned to this organization in the NPPES registry on June 15, 2006.

Where is Nourishing Wellness Medical Center located?

Nourishing Wellness Medical Center is located at 819 N Harbor Dr Ste 310, Redondo Beach, CA 90277. The listed phone number is (310) 373-7830.

What is Nourishing Wellness Medical Center's specialty?

The primary specialty registered for this NPI is Preventive Medicine, specializing in Public Health & General Preventive Medicine, with taxonomy code 2083P0901X.

Is Nourishing Wellness Medical Center enrolled in Medicare?

Yes. Nourishing Wellness Medical Center is registered in the Medicare PECOS enrollment system.

When is Nourishing Wellness Medical Center's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Nourishing Wellness Medical Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Preventive Medicine) reassigns their Medicare billing to Nourishing Wellness Medical Center. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Nourishing Wellness Medical Center was last updated on April 20, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.