Active NPI
Peter J McClure
- Mental Health Counselor
- San Jose, CA
National Provider Identifier
1083780696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1885 Lundy Ave
San Jose, CA 95131-1887 - Phone
- (408) 284-9039
- NPI assigned
- Nov 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1885 Lundy Ave
San Jose, CA 95131-1887
Mailing address
5354 Makati Cir
San Jose, CA 95123-6248
Phone (510) 415-5409
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41707 | Other | CA | COUNTY ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 22, 2024 through Oct 22, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349308800000",
"number": "1083780696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5354 MAKATI CIR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951236248",
"telephone_number": "510-415-5409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1885 LUNDY AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951311887",
"telephone_number": "408-284-9039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLURE",
"first_name": "PETER",
"middle_name": "J",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-27",
"last_updated": "2012-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNTY ID",
"identifier": "41707",
"state": "CA"
}
],
"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 Oct 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.