NPIMap

Organization Active NPI

City of Berkeley

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Berkeley, CA
National Provider Identifier
1710429642
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CITY OF BERKELEY
Practice address
1890 Alcatraz Ave
Berkeley, CA 94703-2715
Phone
(510) 981-5280
NPI assigned
Nov 9, 2016
Last updated
Jul 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

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

Authorized official

Name
Kelly Wallace
Title
Deputy Director
Phone
(510) 981-5107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1890 Alcatraz Ave
Berkeley, CA 94703-2715

Mailing address

3282 Adeline St
Berkeley, CA 94703-2439
Phone (510) 981-5280

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170525001891 CA Part B Supplier - Clinic/Group Practice 5294634606 Receives reassigned benefits from 32 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Berkeley, CA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

1521 University Ave
Berkeley, CA 94703
Phone (510) 981-5249

1980 Allston Way
Berkeley, CA 94704
Phone (510) 644-6121

1980 Allston Way
Bldg H
Berkeley, CA 94704
Phone (510) 644-6965

3282 Adeline St
Berkeley, CA 94703
Phone (510) 981-5280

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594080000000",
    "number": "1710429642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3282 ADELINE ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032439",
            "telephone_number": "510-981-5280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 ALCATRAZ AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032715",
            "telephone_number": "510-981-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF BERKELEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-09",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "510-981-5107"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2020; 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.