NPIMap

Organization Active NPI

Hiawatha Harris, Corporation

Doing business as Pathways To Wellness Medication Clinic

  • Clinical Child & Adolescent Psychologist
  • Martinez, CA
National Provider Identifier
1407063936
Registry record updated Jul 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
C22371 Issued in CA
Legal business name
HIAWATHA HARRIS, CORPORATION
Doing business as
Pathways To Wellness Medication Clinic
Practice address
1210 Alhambra Ave
Martinez, CA 94553-2314
Phone
(925) 520-0005
Fax
(925) 520-0010
NPI assigned
May 16, 2007
Last updated
Jul 8, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2011

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

Authorized official

Name
Neisha BectonNPI 1356522643
Title
C.E.O.
Phone
(925) 520-0005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X C22371 CA Primary
Family Psychologist 103TF0000X C22371 CA
Intellectual & Developmental Disabilities Psychologist 103TM1800X C22371 CA
Marriage & Family Therapist 106H00000X C22371 CA

Addresses

Primary practice location

1210 Alhambra Ave
Martinez, CA 94553-2314

Mailing address

5674 Stoneridge Dr
Suite 207
Pleasanton, CA 94588-8500
Phone (925) 520-0005

Other names 1

  • Pathways To Wellness Medication Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110805000150 CA Part B Supplier - Clinic/Group Practice 1052580115 Receives reassigned benefits from 30 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oakland, CA; Pleasanton, CA; Union City, CA; Martinez, CA

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Hiawatha Harris MD Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310083200000",
    "number": "1407063936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5674 STONERIDGE DR",
            "address_2": "SUITE 207",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945888500",
            "telephone_number": "925-520-0005",
            "fax_number": "925-520-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 ALHAMBRA AVE",
            "city": "MARTINEZ",
            "state": "CA",
            "postal_code": "945532314",
            "telephone_number": "925-520-0005",
            "fax_number": "925-520-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIAWATHA HARRIS, CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2011-07-08",
        "status": "A",
        "authorized_official_last_name": "BECTON",
        "authorized_official_first_name": "NEISHA",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "925-520-0005"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "C22371",
            "primary": true
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "CA",
            "license": "C22371",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "CA",
            "license": "C22371",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "C22371",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pathways To Wellness Medication Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Martinez, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; 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.