NPIMap

Organization Active NPI

Momentum for Mental Health

  • Community/Behavioral Health Agency
  • San Jose, CA
National Provider Identifier
1396055596
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MOMENTUM FOR MENTAL HEALTH
Practice address
86 South 14TH Street
San Jose, CA 95112
Phone
(408) 938-8500
Fax
(408) 286-8988
NPI assigned
Oct 21, 2010
Reactivated
Jul 14, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Authorized official

Name
Jerry McCann
Title
CPRP
Phone
(408) 286-8988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

86 South 14TH Street
San Jose, CA 95112

Mailing address

86 South 14TH Street
San Jose, CA 95112
Phone (408) 938-8500

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

Locations

86 S 14th St
San Jose, CA 95112
Phone (408) 510-7080

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": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1396055596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 SOUTH 14TH STREET",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95112",
            "telephone_number": "408-938-8500",
            "fax_number": "408-286-8988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 SOUTH 14TH STREET",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95112",
            "telephone_number": "408-938-8500",
            "fax_number": "408-286-8988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMENTUM FOR MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-21",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "deactivation_date": "2015-10-07",
        "reactivation_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "MCCANN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CPRP",
        "authorized_official_telephone_number": "408-286-8988"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 14, 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.