International Center for Integrative Medicine

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

INTERNATIONAL CENTER FOR INTEGRATIVE MEDICINE

Practice address

3824 Macarthur Blvd
Oakland, CA 94619-1315

Phone

(510) 336-0129

Fax

(510) 336-0297

NPI assigned

Sep 7, 2014

Last updated

Sep 7, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Amy Matecki, MDNPI 1770571077

Title

President

Phone

(510) 336-0129

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

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.

• Amy Li Matecki, MD

  • Internal Medicine Physician
  • Oakland, CA
  • NPI 1770571077
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1410048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410048000000",
    "number": "1972904183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3824 MACARTHUR BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946191315",
            "telephone_number": "510-336-0129",
            "fax_number": "510-336-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3824 MACARTHUR BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946191315",
            "telephone_number": "510-336-0129",
            "fax_number": "510-336-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL CENTER FOR INTEGRATIVE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-07",
        "last_updated": "2014-09-07",
        "status": "A",
        "authorized_official_last_name": "MATECKI",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-336-0129",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Oakland, CA
• Providers in Oakland, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2014; 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.