Active NPI
Jack Alexander Hawk Wright
- Behavior Technician
- Concord, CA
National Provider Identifier
1316519978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-22-221197
- Practice address
- 1200 Concord Ave Ste 100
Concord, CA 94520-4969 - Phone
- (877) 200-5886
- NPI assigned
- Jul 13, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Behavior Technician | 106S00000X | |||
| Physical Therapist | 225100000X | |||
| Behavior Technician | 106S00000X | RBT-22-221197 | CA | Primary |
Addresses
Primary practice location
1200 Concord Ave Ste 100
Concord, CA 94520-4969
Mailing address
182 Raspberry LN
Freestone, CA 95472-8801
Phone (707) 331-5222
Other practice location 1
39201 State St
Fremont, CA 94538-1437
Phone (866) 206-2008
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 |
|---|---|---|---|
| RBT-22-221197 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666656000000",
"number": "1316519978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "182 RASPBERRY LN",
"city": "FREESTONE",
"state": "CA",
"postal_code": "954728801",
"telephone_number": "707-331-5222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 CONCORD AVE STE 100",
"city": "CONCORD",
"state": "CA",
"postal_code": "945204969",
"telephone_number": "877-200-5886"
}
],
"practiceLocations": [
{
"address_1": "39201 State St",
"address_purpose": "LOCATION",
"city": "Fremont",
"state": "CA",
"postal_code": "945381437",
"country_code": "US",
"telephone_number": "866-206-2008",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WRIGHT",
"first_name": "JACK",
"middle_name": "ALEXANDER HAWK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-13",
"last_updated": "2022-10-25",
"certification_date": "2022-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "RBT-22-221197",
"primary": true
}
],
"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 Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.