DR. PETER S THEODORE PHD
NPI 1487080651
Psychologist in Los Angeles, CA

Active since September 19, 2013PECOS Enrolled
116 N ROBERTSON BLVD, 805, LOS ANGELES, CA 90048(626) 270-3351(626) 284-0550 Get Directions Write a Review

NPPES record last updated: September 19, 2013. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Dr. Peter S Theodore Phd NPPES

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

DR. PETER S THEODORE PHD (NPI 1487080651) is an individual psychologist in Los Angeles, California, licensed in California (PSY22511) and active in the NPI registry since September 2013. He is enrolled in Medicare PECOS and is a graduate of Other (2005).

NPPES Registry Identity

NPI1487080651
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. PETER S THEODORECredential: PHD
Location Address116 N ROBERTSON BLVD, 805Los Angeles, CA 90048-3103
Mailing Address7428 Hollywood Blvd, 202Los Angeles, CA 90046-2800 · (626) 270-3351 · Fax (626) 284-0550
Fax(626) 284-0550
Sole ProprietorYes
Medical School CMSOtherGraduated 2005
Enumeration DateSeptember 19, 2013
✔ NPI 1487080651 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in CA · PSY22511
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
116 N ROBERTSON BLVD, Los Angeles, CA 90048

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Peter S Theodore Phd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7113397993
PECOS Enrollment IDI20260820002358
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.

Medicare Billing Reassignment

Medicare enrollment records show Peter Theodore reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Federally Qualified Health Center (FQHC)
5901 W OLYMPIC BLVD., SUITE 310
Los Angeles, CA 90036
  • Reassigned Medicare billing, California enrollment
  • 34 clinicians in this Medicare group

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

Other Providers at the Same Location NPPES 11

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

Psychiatry & Neurology (Psychiatry)
116 N ROBERTSON BLVD, SUITE 805
LOS ANGELES, CA 90048
Psychologist
116 N ROBERTSON BLVD, SUITE 807
LOS ANGELES, CA 90048
Pathology (Anatomic Pathology)
116 N ROBERTSON BLVD
LOS ANGELES, CA 90048
Pathology (Molecular Genetic Pathology)
116 N ROBERTSON BLVD, SUITE 500
LOS ANGELES, CA 90048
Psychologist
116 N ROBERTSON BLVD, SUITE 706
LOS ANGELES, CA 90048
Psychiatry & Neurology (Psychiatry)
116 N ROBERTSON BLVD, #907
LOS ANGELES, CA 90048
Psychiatry & Neurology (Psychiatry)
116 N ROBERTSON BLVD, #806
LOS ANGELES, CA 90048
Psychiatry & Neurology (Psychiatry)
116 N ROBERTSON BLVD
LOS ANGELES, CA 90048

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 Peter Theodore's NPI number?

The NPI number for Peter Theodore is 1487080651. It was assigned to this individual provider in the NPPES registry on September 19, 2013.

Where is Peter Theodore located?

Peter Theodore practices at 116 N Robertson Blvd 805, Los Angeles, CA 90048. The listed phone number is (626) 270-3351.

What is Peter Theodore's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Peter Theodore enrolled in Medicare?

Yes. Peter Theodore is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Peter Theodore's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Peter Theodore reassigns Medicare benefits to Apla Health & Wellness (Los Angeles, CA). The 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 Peter Theodore's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Peter Theodore was last updated on September 19, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.