CMS-1500 Box 24J / 33a • NPI
1689978652
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LP0808X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health
Box 32 Service Location & ZIP+4
103 BODIN CIR, TRAVIS AFB, CA, 94535-1801
✓ 9-Digit EDI 837 ZIP+4 (94535-1801)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1689978652 (OMOTAYO O ALAMUTU, DNP, FNP, PMHNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1689978652 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | OMOTAYO O ALAMUTU, DNP, FNP, PMHNP |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health NUCC Code: 363LP0808X (Nurse Practitioner, Psych/Mental Health) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 103 BODIN CIR, TRAVIS AFB, CA, 94535-1801 |
| Practice Telephone / Fax | Tel: (707) 908-5630 |
| Administrative Mailing Address | 12301 WILSHIRE BLVD STE 512, LOS ANGELES, CA, 90025-1053 |
| Enumeration & Last Sync | Enumerated: 2011-01-05 | CMS Record Updated: 2026-11-06 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LP0808X)
What Does Taxonomy Code 363LP0808X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LP0808X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (OMOTAYO O ALAMUTU, DNP, FNP, PMHNP)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363LP0808X — Nurse Practitioner, Psych/Mental HealthPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health | State: CA | License: 19624 | Primary: Yes (Primary) |
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: CA | License: 19624 | Primary: Secondary |
Medical Billing, RCM & Hospital Credentialing Teams:
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