KETAVITA WELLNESS CLINIC PC
NPI 1649162439
Clinic/Center in Wyckoff, NJ
About Ketavita Wellness Clinic Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KETAVITA WELLNESS CLINIC PC (NPI 1649162439) is a healthcare organization registered as a clinic/center in Wyckoff, New Jersey and active in the NPI registry since July 2025. The organization lists Mehdi Pouria, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ketavita Wellness Clinic Pc 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 Ketavita Wellness Clinic PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 Ketavita Wellness Clinic PC's NPI number?
The NPI number for Ketavita Wellness Clinic PC is 1649162439. It was assigned to this organization in the NPPES registry on July 16, 2025.
Where is Ketavita Wellness Clinic PC located?
Ketavita Wellness Clinic PC is located at 365 Franklin Ave, Wyckoff, NJ 07481. The listed phone number is (925) 565-8498.
What is Ketavita Wellness Clinic PC's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Ketavita Wellness Clinic PC enrolled in Medicare?
Yes. Ketavita Wellness Clinic PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Ketavita Wellness Clinic PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Ketavita Wellness Clinic PC. 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 Ketavita Wellness Clinic PC was last updated on October 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Ketavita Wellness Clinic Pc · NPI 1649162439
Clinic/Center organization in Wyckoff, New Jersey. Organization record, active in the CMS NPPES registry since July 16, 2025.
## Identity
- **NPI:** 1649162439 (Entity type: Organization)
- **Enumerated:** July 16, 2025
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Organization subpart:** No
- **Authorized official:** Mehdi Pouria, OWNER
## Practice location
- **Address:** 365 FRANKLIN AVE, Wyckoff, NJ 07481-1971
- **Phone:** (925) 565-8498
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 24, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1649162439) · Data from the CMS NPPES public registry.