Active NPI
Kimberly Lyles Butts
- Peer Specialist
- San Leandro, CA
National Provider Identifier
1073099552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 545 Estudillo Ave
San Leandro, CA 94577-4611 - Phone
- (510) 352-9200
- NPI assigned
- Jul 17, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Community Health Worker | 172V00000X | MPSS-MKHLRT | CA | |
| Peer Specialist | 175T00000X | Primary |
Addresses
Primary practice location
545 Estudillo Ave
San Leandro, CA 94577-4611
Mailing address
1065 A St
Hayward, CA 94541-4148
Phone (510) 459-5294
Other practice location 1
1515 Market St
Oakland, CA 94607-5001
Phone (510) 730-5687
Other practice location 2
545 Estudillo Ave
San Leandro, CA 94577-4611
Phone (510) 352-9200 ext. 201
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B9627718 | Other | CA | CALIFORNIA ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MPSS-MKHLRT | CA | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738886400000",
"number": "1073099552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1065 A ST",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945414148",
"telephone_number": "510-459-5294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 ESTUDILLO AVE",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774611",
"telephone_number": "510-352-9200"
}
],
"practiceLocations": [
{
"address_1": "1515 Market St",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "946075001",
"country_code": "US",
"telephone_number": "510-730-5687",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "545 Estudillo Ave",
"address_purpose": "LOCATION",
"city": "San Leandro",
"state": "CA",
"postal_code": "945774611",
"country_code": "US",
"telephone_number": "510-352-9200 x201",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BUTTS",
"first_name": "KIMBERLY",
"middle_name": "LYLES",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-17",
"last_updated": "2025-02-07",
"certification_date": "2025-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CA",
"license": "MPSS-MKHLRT",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA ID",
"identifier": "B9627718",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.