NPIMap

Organization Active NPI

Sondermind PC

  • Clinical Social Worker
  • San Jose, CA
National Provider Identifier
1003646977
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SONDERMIND PC
Practice address
6203 San Ignacio Ave Ste 110
San Jose, CA 95119-1358
Phone
(844) 843-7279
NPI assigned
Aug 6, 2024
Last updated
Nov 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tanya Roach
Title
Chief Administrative Cred Officer
Phone
(844) 843-7279

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

6203 San Ignacio Ave Ste 110
San Jose, CA 95119-1358

Mailing address

6203 San Ignacio Ave Ste 110
San Jose, CA 95119-1358
Phone (844) 843-7279

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, NC, CA, TX, WV5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20241125001063 IL Part B Supplier - Clinic/Group Practice 0547795791 Receives reassigned benefits from 93 practitioners
Practice locations: Peoria, IL
O20250117002545 NC Part B Supplier - Clinic/Group Practice 0547795791 Receives reassigned benefits from 101 practitioners
Practice locations: Durham, NC
O20250127000871 CA Part B Supplier - Clinic/Group Practice 0547795791 Receives reassigned benefits from 61 practitioners
Practice locations: Valencia, CA; Walnut Creek, CA
O20260210002813 TX Part B Supplier - Clinic/Group Practice 0547795791 Receives reassigned benefits from 1 practitioner
Practice locations: Austin, TX
O20260407002027 WV Part B Supplier - Clinic/Group Practice 0547795791 Receives reassigned benefits from 1 practitioner
Practice locations: Fairmont, WV

National Provider Directory

National Provider Directory

Locations

2530 Meridian Pkwy
Fl 3
Durham, NC 27713
Phone (919) 389-7316

Practitioners & affiliated clinicians

Practitioners 254

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 254

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732233600000",
    "number": "1003646977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6203 SAN IGNACIO AVE STE 110",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951191358",
            "telephone_number": "844-843-7279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6203 SAN IGNACIO AVE STE 110",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951191358",
            "telephone_number": "844-843-7279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONDERMIND PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE CRED OFFICER",
        "authorized_official_telephone_number": "844-843-7279"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.