Active NPI
Matthew Van Pelt
- Marriage & Family Therapist
- Alameda, CA
National Provider Identifier
1477204865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 139825
- Practice address
- 564 Central Ave Apt 124
Alameda, CA 94501-3749 - Phone
- (510) 859-4448
- NPI assigned
- Jan 17, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 139825 | CA | Primary |
Addresses
Primary practice location
564 Central Ave Apt 124
Alameda, CA 94501-3749
Mailing address
564 Central Ave Apt 124
Alameda, CA 94501-3749
Phone (310) 804-5330
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 29, 2024 through Jan 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690675200000",
"number": "1477204865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "564 CENTRAL AVE APT 124",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945013749",
"telephone_number": "310-804-5330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "564 CENTRAL AVE APT 124",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945013749",
"telephone_number": "510-859-4448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN PELT",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-01-17",
"last_updated": "2023-07-30",
"certification_date": "2023-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "139825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alameda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.