WHITNEY NELSON M.D.
NPI 1265973523
Hospitalist in Irvine, CA

Active since March 19, 2017PECOS EnrolledAccepts Medicare Assignment
86.1/100
CMS Quality Rating
16200 SAND CANYON AVE, IRVINE, CA 92618(949) 873-6181 Get Directions Write a Review

NPPES record last updated: July 11, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 11, 2025, Mar 7, 2023, Oct 15, 2020 and 2 more (5 updates tracked since 2017).

About Whitney Nelson M.d. NPPES

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

WHITNEY NELSON M.D. (NPI 1265973523) is an individual hospitalist provider in Irvine, California, licensed in California (A160145) and active in the NPI registry since March 2017. She is enrolled in Medicare PECOS, maintains a secondary practice location in Los Angeles, and is a graduate of Tulane University School Of Medicine (2017).

NPPES Registry Identity

NPI1265973523
Entity TypeIndividualFemale
Primary Taxonomy208M00000X
Provider Legal NameWHITNEY NELSONCredential: M.D.
Location Address16200 SAND CANYON AVEIrvine, CA 92618-3714
Mailing Address361 Hospital Rd Ste 521Newport Beach, CA 92663-3526 · (949) 734-7836
Sole ProprietorNo
Medical School CMSTulane University School Of MedicineGraduated 2017
Enumeration DateMarch 19, 2017
Last NPPES UpdateJuly 11, 20255 updates tracked since enumeration
NPPES CertifiedJuly 11, 2025
NPI 1265973523 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyHospitalistAllopathic & Osteopathic Physicians
Taxonomy Code208M00000X
License Licensed in CA · A160145
Definition

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.

Also ListedInternal MedicineTaxonomy 207R00000X · License A160145 (CA)
16200 SAND CANYON AVE, Irvine, CA 92618

Secondary Practice Location 1

Location 1757 Westwood Plz, Suite 7501Los Angeles, CA 90095-8358 · Phone (310) 339-5952

Other Identifiers 1

OtherA160145CA · State License

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Whitney Nelson M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6305278193
PECOS Enrollment IDI20200622000630
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.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
299 services139 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
103 services103 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
99 services98 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
75 services48 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
27 services23 patients
Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
18 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92618 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
$142.39 typical visit price
range $62.96 – $187.60
Typical copayment $35.59 (range $15.74 – $46.90)
Most-billed visit code 99204
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.

86.1/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality82.93
Promoting Interoperability100
Improvement Activities40
Cost66.73

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
2 suppliers14 claims14 services$15.84 avg. paid by Medicare
Nebulizer, with compressor E0570
DME-Other DME · category DE000N
2 suppliers16 claims16 services$3.44 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
2 suppliers14 claims14 services$75.98 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

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

Social Worker (Clinical)
16200 SAND CANYON AVE
IRVINE, CA 92618
Emergency Medicine
16200 SAND CANYON AVE
IRVINE, CA 92618
Hospitalist
16200 SAND CANYON AVE
IRVINE, CA 92618
Hospitalist
16200 SAND CANYON AVE
IRVINE, CA 92618
Social Worker (Clinical)
16200 SAND CANYON AVE
IRVINE, CA 92618
Emergency Medicine (Emergency Medical Services)
16200 SAND CANYON AVE
IRVINE, CA 92618
Emergency Medicine (Emergency Medical Services)
16200 SAND CANYON AVE
IRVINE, CA 92618
General Acute Care Hospital
16200 SAND CANYON AVE
IRVINE, CA 92618

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 Whitney Nelson's NPI number?

The NPI number for Whitney Nelson is 1265973523. It was assigned to this individual provider in the NPPES registry on March 19, 2017.

Where is Whitney Nelson located?

Whitney Nelson practices at 16200 Sand Canyon Ave, Irvine, CA 92618. The listed phone number is (949) 873-6181.

What is Whitney Nelson's specialty?

The primary specialty registered for this NPI is Hospitalist with taxonomy code 208M00000X.

Is Whitney Nelson enrolled in Medicare?

Yes. Whitney Nelson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Whitney Nelson was last updated on July 11, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.