NPIMap

Organization Active NPI

Momentum for Mental Health - a.S.S.I.S.T. Solano Outpatient

  • Psychologist
  • Fairfield, CA
National Provider Identifier
1336367010
Registry record updated Aug 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MOMENTUM FOR MENTAL HEALTH - A.S.S.I.S.T. SOLANO OUTPATIENT
Practice address
1935 Kidder Ave
Fairfield, CA 94533-3919
Phone
(707) 425-2741
Fax
(707) 425-2862
NPI assigned
Apr 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2008

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

Authorized official

Name
John S. Smelser
Title
Chief Financial Officer
Phone
(408) 261-7777

Specialties & licenses 1

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

Addresses

Primary practice location

1935 Kidder Ave
Fairfield, CA 94533-3919

Mailing address

2001 The Alameda
San Jose, CA 95126-1136
Phone (408) 261-7777

Other identifiers 1

IdentifierTypeStateIssuer
48ASMedicaidCA

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217980800000",
    "number": "1336367010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 THE ALAMEDA",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951261136",
            "telephone_number": "408-261-7777",
            "fax_number": "408-554-9960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 KIDDER AVE",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333919",
            "telephone_number": "707-425-2741",
            "fax_number": "707-425-2862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMENTUM FOR MENTAL HEALTH - A.S.S.I.S.T. SOLANO OUTPATIENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2008-08-06",
        "status": "A",
        "authorized_official_last_name": "SMELSER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "408-261-7777"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48AS",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; 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.