NEURODIVERGENT PSYCHIATRIC SPECIALISTS
NPI 1417848219
Internal Medicine in Santa Ana, CA

Q: What is Neurodivergent Psychiatric Specialists's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since July 10, 2025

2112 E 4TH ST, STE 228A, SANTA ANA, CA 92705(949) 409-6460(949) 749-7433 Get Directions Write a Review

NPPES record last updated: December 8, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 8, 2025, Oct 9, 2025, Sep 18, 2025 and 2 more (5 updates tracked since 2025).

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About Neurodivergent Psychiatric Specialists NPPES

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

NEURODIVERGENT PSYCHIATRIC SPECIALISTS (NPI 1417848219) is a healthcare organization registered as an internal medicine in Santa Ana, California and active in the NPI registry since July 2025. The organization lists Jesse Anthony Bonilla, Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1417848219

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameNEURODIVERGENT PSYCHIATRIC SPECIALISTS

Location Address2112 E 4TH ST, STE 228ASanta Ana, CA 92705-3840

Mailing Address2112 E 4th St Ste 228Santa Ana, CA 92705-3840 · (949) 409-6460 · Fax (949) 749-7433

Phone(949) 409-6460

Fax(949) 749-7433

Organization SubpartNo

Authorized OfficialJesse Anthony BonillaExecutive Officer · (714) 420-9890

Enumeration DateJuly 10, 2025

Last NPPES UpdateDecember 8, 20255 updates tracked since enumeration

NPPES CertifiedDecember 8, 2025

✔ NPI 1417848219 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X

Also ListedGeneral PracticeTaxonomy 208D00000X

Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X

2112 E 4TH ST, Santa Ana, CA 92705

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Other Names 1

Doing Business AsNeurodivergent Psychiatric Specialists

Other Identifiers 1

MedicaidCB540002CA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Neurodivergent Psychiatric Specialists is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Neurodivergent Psychiatric Specialists, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jesse Bonilla, PMHNP-BC

Nurse Practitioner

NPI 1689440711

2112 E 4TH ST STE 228A
Santa Ana, CA 92705

(714) 420-9890

✔ PECOSSame 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 Neurodivergent Psychiatric Specialists's NPI number?

The NPI number for Neurodivergent Psychiatric Specialists is 1417848219. It was assigned to this organization in the NPPES registry on July 10, 2025.

Where is Neurodivergent Psychiatric Specialists located?

Neurodivergent Psychiatric Specialists is located at 2112 E 4th St Ste 228A, Santa Ana, CA 92705. The listed phone number is (949) 409-6460.

What is Neurodivergent Psychiatric Specialists's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Neurodivergent Psychiatric Specialists enrolled in Medicare?

Yes. Neurodivergent Psychiatric Specialists is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Neurodivergent Psychiatric Specialists?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Neurodivergent Psychiatric Specialists. 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 Neurodivergent Psychiatric Specialists was last updated on December 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.