NPI |
1134679533 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
ROOT & STEM INTEGRATIVE CHINESE MEDICINE |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider First Line Business Practice Location Address |
3515 GRAND AVE |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Business Practice Location Address City Name |
OAKLAND |
The first name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address State Name |
CA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
946102037 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
5104634304 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
10/10/2016 |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Last Update Date |
10/10/2016 |
The city name in the location address of the provider being identified. |
Authorized Official Last Name |
PARKER |
The State code in the location of the provider
being identified. |
Authorized Official First Name |
JESSICA |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Authorized Official Title or Position |
OWNER |
The country code in the location address of the provider being identified. |
Authorized Official Telephone Number |
5104634304 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
171100000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
13468 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
CA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
DR. |
|
Authorized Official Credential Text |
DAOM |
|
Healthcare Provider Taxonomy Group 1 |
193400000X MULTIPLE SINGLE SPECIALTY GROUP |
|