NPIMap

Organization Active NPI

Momentum for Health - FSP Imd

  • Psychologist
  • San Jose, CA
National Provider Identifier
1285877308
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MOMENTUM FOR HEALTH - FSP IMD
Practice address
86 S 14TH St
San Jose, CA 95112-2015
Phone
(408) 938-8500
Fax
(408) 295-4231
NPI assigned
Apr 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Authorized official

Name
David K. Mineta
Title
Ceo
Phone
(669) 213-0755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

86 S 14TH St
San Jose, CA 95112-2015

Mailing address

1922 The Alameda
San Jose, CA 95126-1457
Phone (408) 642-6053

Other names 1

  • Momentum for Mental Health - FSP IMD Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040618001294 CA Part B Supplier - Clinic/Group Practice 2769377217 Receives reassigned benefits from 101 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Jose, CA; Palo Alto, CA; Mountain View, CA

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Momentum for Mental Health - Assist Solano Outpatient39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672185600000",
    "number": "1285877308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1922 THE ALAMEDA",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951261457",
            "telephone_number": "408-642-6053",
            "fax_number": "408-642-6049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 S 14TH ST",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951122015",
            "telephone_number": "408-938-8500",
            "fax_number": "408-295-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMENTUM FOR HEALTH - FSP IMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-20",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A",
        "authorized_official_last_name": "MINETA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "669-213-0755"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Momentum for Mental Health - FSP IMD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 28, 2022; 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.