Maryam Jabbari Amiri

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

3075 Adeline St Ste 120
Berkeley, CA 94703-2579

Phone

(510) 848-1112

NPI assigned

Sep 1, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Through the Looking Glass

  • Community/Behavioral Health Agency
  • Berkeley, CA
  • NPI 1528267028
  NPD

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

{
    "created_epoch": "1535760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1740762178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3075 ADELINE ST STE 120",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032579",
            "telephone_number": "510-848-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 ADELINE ST STE 120",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032579",
            "telephone_number": "510-848-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JABBARI AMIRI",
        "first_name": "MARYAM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-01",
        "last_updated": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10725 International Dr",
            "city": "Rancho Cordova",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956707967",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maki Itoh, MFT INTERN
• Joshua Gregg Iufer, RD
• Susan Lee Ivey, MD
• Jessica Ellison Izquierdo
• Judith Ann Izzo, L.C.S.W.
• Nancy Jo Jackson Carlson
• Briahna Ciboney Jackson
• De'Aunte Jackson
• Genee Delyene Jackson, PH.D.
• Helen Maria Jackson, M.D.

• Student in an Organized Health Care Education/Training Program in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; 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.