KARISSA NICHOLE CHISUM PMHNP-BC
NPI 1558042101
Nurse Practitioner - Psychiatric/Mental Health in Costa Mesa, CA
About Karissa Nichole Chisum Pmhnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KARISSA NICHOLE CHISUM PMHNP-BC (NPI 1558042101) is an individual psychiatric/mental health provider in Costa Mesa, California, licensed in California (95024718) and active in the NPI registry since July 2023. She is enrolled in Medicare PECOS and maintains a secondary practice location in Costa Mesa.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Karissa Nichole Chisum Pmhnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Karissa Chisum reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Scottsdale, AZ 85253
- Reassigned Medicare billing, California enrollment
- 766 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92627 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 17
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
COSTA MESA, CA 92627
COSTA MESA, CA 92627
COSTA MESA, CA 92627
COSTA MESA, CA 92627
COSTA MESA, CA 92627
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 Karissa Chisum's NPI number?
The NPI number for Karissa Chisum is 1558042101. It was assigned to this individual provider in the NPPES registry on July 27, 2023.
Where is Karissa Chisum located?
Karissa Chisum practices at 1640 Newport Blvd Ste 110, Costa Mesa, CA 92627. The listed phone number is (925) 282-1778.
What is Karissa Chisum's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Karissa Chisum enrolled in Medicare?
Yes. Karissa Chisum is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Karissa Chisum's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Karissa Chisum reassigns Medicare benefits to Pacific Coast Psychiatric Associates Inc (Scottsdale, AZ). 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 Karissa Chisum'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 Karissa Chisum was last updated on May 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Karissa Nichole Chisum, PMHNP-BC · NPI 1558042101
Psychiatric/Mental Health physician in Costa Mesa, California. Individual provider, active in the CMS NPPES registry since July 27, 2023.
## Identity
- **NPI:** 1558042101 (Entity type: Individual)
- **Enumerated:** July 27, 2023
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 95024718 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1640 NEWPORT BLVD STE 110, Costa Mesa, CA 92627-7762
- **Phone:** (925) 282-1778
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Pacific Coast Psychiatric Associates Inc (NPI 1023125465, Scottsdale, AZ), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 24, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1558042101) · Data from the CMS NPPES public registry.