JAQUELINE ALEXIS GORODETSKY PMHNP
NPI 1619730660
Nurse Practitioner - Psychiatric/Mental Health in Panorama City, CA
About Jaqueline Alexis Gorodetsky Pmhnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JAQUELINE ALEXIS GORODETSKY PMHNP (NPI 1619730660) is an individual psychiatric/mental health provider in Panorama City, California, licensed in California (95027727) and active in the NPI registry since February 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jaqueline Alexis Gorodetsky Pmhnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jaqueline Gorodetsky reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Panorama City, CA 91402
- Reassigned Medicare billing, California enrollment
- 95 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 91402 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 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PANORAMA CITY, CA 91402
PANORAMA CITY, CA 91402
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 Jaqueline Gorodetsky's NPI number?
The NPI number for Jaqueline Gorodetsky is 1619730660. It was assigned to this individual provider in the NPPES registry on February 2, 2024.
Where is Jaqueline Gorodetsky located?
Jaqueline Gorodetsky practices at 14860 Roscoe Blvd Ste 307, Panorama City, CA 91402. The listed phone number is (818) 616-2122.
What is Jaqueline Gorodetsky's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Jaqueline Gorodetsky enrolled in Medicare?
Yes. Jaqueline Gorodetsky is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jaqueline Gorodetsky's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jaqueline Gorodetsky reassigns Medicare benefits to Innovative Medical Solutions Inc A Medical Group (Panorama City, 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 Jaqueline Gorodetsky'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 Jaqueline Gorodetsky was last updated on January 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.
# Jaqueline Alexis Gorodetsky, PMHNP · NPI 1619730660
Psychiatric/Mental Health physician in Panorama City, California. Individual provider, active in the CMS NPPES registry since February 2, 2024.
## Identity
- **NPI:** 1619730660 (Entity type: Individual)
- **Enumerated:** February 2, 2024
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 95027727 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 14860 ROSCOE BLVD STE 307, Panorama City, CA 91402-4691
- **Phone:** (818) 616-2122
## 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:** Innovative Medical Solutions Inc A Medical Group (NPI 1972624955, Panorama City, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** January 1, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1619730660) · Data from the CMS NPPES public registry.