NPIMap

Organization Active NPI

San Mateo County

  • Adolescent and Children Mental Health Clinic/Center
  • Pacifica, CA
National Provider Identifier
1700978574
Registry record updated Mar 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
SAN MATEO COUNTY
Practice address
1450 Terra Nova Blvd
Rooms 222 and 223
Pacifica, CA 94044-3615
Phone
(650) 994-4395
NPI assigned
Sep 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2024

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

Authorized official

Name
Jei Africa
Title
Director
Phone
(650) 613-2155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

1450 Terra Nova Blvd
Rooms 222 and 223
Pacifica, CA 94044-3615

Mailing address

1450 Terra Nova Blvd RM 222
Pacifica, CA 94044-3615
Phone (650) 994-4395

Other names 1

  • Jefferson Union High School District (JUHSD) TDS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031126000292 CA Part B Supplier - Clinic/Group Practice 9032023171 Receives reassigned benefits from 605 practitioners
36 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Redwood City, CA; San Mateo, CA; San Bruno, CA; South San Francisco, CA; Woodside, CA; Daly City, CA; Belmont, CA; Colma, CA…

Other NPIs on the same Medicare enrollment 36

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

View all 36

National Provider Directory

National Provider Directory
Tax ID family
Harold D Chope Comm Pat123 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

699 Serramonte Blvd
Rm 300
Daly City, CA 94015
Phone (650) 550-7927

1450 Terra Nova Blvd
Rm 222
Pacifica, CA 94044
Phone (650) 994-4395

Practitioners & affiliated clinicians

Practitioners 12

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": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710979200000",
    "number": "1700978574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 TERRA NOVA BLVD RM 222",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940443615",
            "telephone_number": "650-994-4395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 TERRA NOVA BLVD",
            "address_2": "ROOMS 222 AND 223",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940443615",
            "telephone_number": "650-994-4395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MATEO COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A",
        "authorized_official_last_name": "AFRICA",
        "authorized_official_first_name": "JEI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "650-613-2155"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Union High School District (JUHSD) TDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pacifica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; 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.