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ADIN SAMUEL VAEWSORN RN, PMHNP
NPI 1932719192
Nurse Practitioner - Psychiatric/Mental Health in Oakland, CA

Active since August 03, 2020PECOS Enrolled
1501 FRUITVALE AVE, OAKLAND, CA 94601(510) 635-5200 Get Directions Write a Review

NPPES record last updated: March 19, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 19, 2025, May 23, 2022, Aug 3, 2020 (3 updates tracked since 2020).

About Adin Samuel Vaewsorn Rn, Pmhnp NPPES

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

ADIN SAMUEL VAEWSORN RN, PMHNP (NPI 1932719192) is an individual psychiatric/mental health provider in Oakland, California, licensed in California (95018370) and active in the NPI registry since August 2020. He is enrolled in Medicare PECOS, maintains a secondary practice location in Oakland, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1932719192
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameADIN SAMUEL VAEWSORNCredential: RN, PMHNP
Location Address1501 FRUITVALE AVEOakland, CA 94601-2322
Mailing Address1501 Fruitvale AveOakland, CA 94601-2322 · (510) 635-5200
Phone(510) 635-5200
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateAugust 3, 2020
Last NPPES UpdateMarch 19, 20253 updates tracked since enumeration
NPPES CertifiedMarch 19, 2025
✔ NPI 1932719192 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in CA · 95018370
Also ListedRegistered NurseTaxonomy 163W00000X · License 95204521 (CA)
1501 FRUITVALE AVE, Oakland, CA 94601
Open in Google Maps ↗

Secondary Practice Location 1

Location 11605 Jefferson StOakland, CA 94612-1215 · Phone (510) 923-1099

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Adin Samuel Vaewsorn Rn, Pmhnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9234517657
PECOS Enrollment IDI20220525002404
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 Reassignments

2

Medicare enrollment records show Adin Vaewsorn reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

La Clinica De La Raza, Inc.
Same address
Federally Qualified Health Center (FQHC)
1501 FRUITVALE AVE
Oakland, CA 94601
  • Reassigned Medicare billing, California enrollment
  • 187 clinicians in this Medicare group
NPI 1174639116 (510) 535-6200
Bonita House, Inc.
2.8 mi
Case Management
7200 BANCROFT AVE STE 267
Oakland, CA 94605
  • Reassigned Medicare billing, California enrollment
  • 8 clinicians in this Medicare group
NPI 1053526715 (510) 735-0864

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 94601 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$104.51 typical visit price
range $69.00 – $202.35
Typical copayment $26.12 (range $17.25 – $50.58)
Most-billed visit code 99203
Established Patient
$119.48 typical visit price
range $23.44 – $166.46
Typical copayment $29.87 (range $5.86 – $41.61)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

ENRIQUE LOPEZ-CASTRO
Counselor
1501 FRUITVALE AVE
OAKLAND, CA 94601
Alameda County (510) 535-6200
VICTORIA TINOCO
Case Manager/Care Coordinator
1501 FRUITVALE AVE
OAKLAND, CA 94601
Alameda County (510) 535-6200
FUENSANTA BOTELLO MD
Psychiatry & Neurology (Psychiatry)
1501 FRUITVALE AVE
OAKLAND, CA 94601
Alameda County (510) 535-6200
MOLSES GARCIA LEMUS MFT
Marriage & Family Therapist
1501 FRUITVALE AVE
OAKLAND, CA 94601
Alameda County (510) 535-6200
LUZ ISLAS BYRD MFT
Marriage & Family Therapist
1501 FRUITVALE AVE
OAKLAND, CA 94601
Alameda County (510) 535-6200
SEAN SEWARD-KATZMILLER MFT INTERN
Marriage & Family Therapist
1501 FRUITVALE AVE
OAKLAND, CA 94601
Alameda County (510) 535-6200
ANA MARIA GARCIA-RUBIO
Marriage & Family Therapist
1501 FRUITVALE AVE
OAKLAND, CA 94601
Alameda County (510) 535-6200
OSCAR CONTRERAS
Social Worker
1501 FRUITVALE AVE
OAKLAND, CA 94601
Alameda County (510) 535-6200

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 Adin Vaewsorn's NPI number?

The NPI number for Adin Vaewsorn is 1932719192. It was assigned to this individual provider in the NPPES registry on August 3, 2020.

Where is Adin Vaewsorn located?

Adin Vaewsorn practices at 1501 Fruitvale Ave, Oakland, CA 94601. The listed phone number is (510) 635-5200.

What is Adin Vaewsorn's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Adin Vaewsorn enrolled in Medicare?

Yes. Adin Vaewsorn is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Adin Vaewsorn's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Adin Vaewsorn reassigns Medicare benefits to 2 organizations: La Clinica De La Raza, Inc. (Oakland, CA) and Bonita House, Inc. (Oakland, CA). Each 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 Adin Vaewsorn'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 Adin Vaewsorn was last updated on March 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.