Individual provider Active NPI

Jermaine Varian, OTR/L

  • Occupational Therapist
  • Concord, CA
National Provider Identifier
1104299932
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
14505 Issued in CA
Practice address
4367 Concord Blvd
Concord, CA 94521-1145
Phone
(510) 381-2654
NPI assigned
Nov 2, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 14505 CA Primary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X 16-0721 NV

Addresses

Primary practice location

4367 Concord Blvd
Concord, CA 94521-1145

Mailing address

325 Brighton St
Hercules, CA 94547-3699
Phone (510) 381-2654

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

LicenseStateTypeSpecialty
14505CAMDPsychologist
16-0721NVMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1446422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1104299932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 BRIGHTON ST",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "945473699",
            "telephone_number": "510-381-2654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4367 CONCORD BLVD",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945211145",
            "telephone_number": "510-381-2654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARIAN",
        "first_name": "JERMAINE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-11-02",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "14505",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "NV",
            "license": "16-0721",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.