Individual provider Active NPI

Samuel Joseph Yepez Jr., CCAPP

  • Addiction (Substance Use Disorder) Counselor
  • Fremont, CA
National Provider Identifier
1689864514
Registry record updated Mar 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
C041880118 Issued in CA
Practice address
3155 Kearny Street #150
Fremont, CA 94538
Phone
(844) 682-7215
Fax
(510) 771-9910
NPI assigned
Jul 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 60986 CA
Addiction (Substance Use Disorder) Counselor 101YA0400X C041880118 CA Primary

Addresses

Primary practice location

3155 Kearny Street #150
Fremont, CA 94538

Mailing address

1231N Elgin Street
San Leandro, CA 94578
Phone (510) 586-1744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
C041880118CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
The Alliance for Community Wellness PastSince Mar 12, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709856000000",
    "number": "1689864514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231N ELGIN STREET",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "94578",
            "telephone_number": "510-586-1744",
            "fax_number": "510-535-2346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3155 KEARNY STREET #150",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "94538",
            "telephone_number": "844-682-7215",
            "fax_number": "510-771-9910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEPEZ",
        "first_name": "SAMUEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CCAPP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-26",
        "last_updated": "2024-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "60986",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "C041880118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; 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.