| NPI |
1790986628 |
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 |
1 |
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 Last Name Legal Name |
KIRKPATRICK |
The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider First Name |
JAMES |
The first name of the provider, if the provider
is an individual. |
| Provider Middle Name |
M |
The middle name of the provider, if the provider
is an individual. |
| Provider Name Prefix Text |
MR. |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
| Provider Credential Text |
MFT |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
| Provider First Line Business Practice Location Address |
1727 MARTIN LUTHER KING JR WAY |
The first 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. |
| Provider Second Line Business Practice Location Address |
SUITE 109 |
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. |
| Provider Business Practice Location Address City Name |
OAKLAND |
The city name in the location address of the provider being identified. |
| 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 |
946121358 |
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 |
5108939230 |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number |
5108932074 |
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 Enumeration Date |
5/29/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
7/8/2007 |
The telephone number associated with the location address of the provider being identified. |
| Provider Gender Code |
F |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Healthcare Provider Taxonomy Code 1 |
106H00000X |
The date that a record was last updated or changed. |
| Provider License Number 1 |
MFC 17408 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Provider License Number State Code 1 |
CA |
The first name of the authorized official. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The title or position of the authorized official. |
| Is Sole Proprietor |
N |
The 10-position telephone number of the authorized official. |