NPIMap

Individual provider Active NPI

Shane Robert Wallin

  • Clinical Social Worker
  • San Leandro, CA
National Provider Identifier
1326243221
Registry record updated Apr 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
28659 Issued in CA
Practice address
2275 Arlington Dr
San Leandro, CA 94578-1132
Phone
(510) 847-4325
NPI assigned
Jun 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 28659 CA Primary

Addresses

Primary practice location

2275 Arlington Dr
San Leandro, CA 94578-1132

Mailing address

2513 24TH St
San Francisco, CA 94110-3556
Phone (415) 238-5698

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Seneca Family of Agencies Past Accepting new patients
Rocketship Education Wisconsin Inc. Past Accepting new patients
Seneca Family of Agencies Past Accepting new patients
Seneca Center Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428278400000",
    "number": "1326243221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2513 24TH ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941103556",
            "telephone_number": "415-238-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 ARLINGTON DR",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945781132",
            "telephone_number": "510-847-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIN",
        "first_name": "SHANE",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-19",
        "last_updated": "2015-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "28659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Leandro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; 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.