NPIMap

Organization Active NPI

East Ivy Panacea Inc

Doing business as Lumos Psychiatric Services

  • Psychiatry Physician
  • San Jose, CA
National Provider Identifier
1184229577
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
EAST IVY PANACEA INC
Doing business as
Lumos Psychiatric Services
Practice address
2516 Samaritan Dr Ste B
San Jose, CA 95124-4108
Phone
(408) 442-5326
NPI assigned
Dec 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

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

Authorized official

Name
Dr. Sarbani Maitra, MDNPI 1134360647
Title
Ceo
Phone
(408) 442-5326

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2516 Samaritan Dr Ste B
San Jose, CA 95124-4108

Mailing address

16320 Alexander CT
Monte Sereno, CA 95030-5204

Other names 1

  • Lumos Psychiatric Services Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smaitra@lumosclinical.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1606867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606867200000",
    "number": "1184229577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16320 ALEXANDER CT",
            "city": "MONTE SERENO",
            "state": "CA",
            "postal_code": "950305204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 SAMARITAN DR STE B",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951244108",
            "telephone_number": "408-442-5326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST IVY PANACEA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-02",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A",
        "authorized_official_last_name": "MAITRA",
        "authorized_official_first_name": "SARBANI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "408-442-5326",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smaitra@lumosclinical.com",
            "affiliation": "N",
            "endpointDescription": "Organizational email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2516 Samaritan Dr Ste B",
            "city": "San Jose",
            "state": "CA",
            "country_code": "US",
            "postal_code": "951244108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lumos Psychiatric Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 2, 2020; 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.