NPIMap

Organization Active NPI

River Street Integrative Medicine, Inc.

  • General Practice Physician
  • Santa Cruz, CA
National Provider Identifier
1417293267
Registry record updated Jun 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A79910 Issued in CA
Legal business name
RIVER STREET INTEGRATIVE MEDICINE, INC.
Practice address
700 River St
Santa Cruz, CA 95060-2748
Phone
(831) 457-2000
Fax
(831) 457-2140
NPI assigned
Dec 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2013

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

Authorized official

Name
Dr. Lester Jay Brodie, M.D.
Title
Medical Doctor
Phone
(831) 457-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X A79910 CA Primary

Addresses

Primary practice location

700 River St
Santa Cruz, CA 95060-2748

Mailing address

700 River St
Santa Cruz, CA 95060-2748
Phone (831) 457-2000

National Provider Directory

National Provider Directory

Locations

700 River St
Santa Cruz, CA 95060
Phone (831) 216-5603

Practitioners & affiliated clinicians

Practitioners 7

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": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1417293267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 RIVER ST",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950602748",
            "telephone_number": "831-457-2000",
            "fax_number": "831-457-2140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 RIVER ST",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950602748",
            "telephone_number": "831-457-2000",
            "fax_number": "831-457-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER STREET INTEGRATIVE MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-26",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "BRODIE",
        "authorized_official_first_name": "LESTER",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "831-457-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A79910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; 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.