Individual provider Active NPI

Brandon Edward Tomlin, LCSW

  • Clinical Social Worker
  • Eureka, CA
National Provider Identifier
1013234418
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
104793 Issued in CA
Practice address
2200 Tydd St
Eureka, CA 95501-1284
Phone
(707) 441-1624
Fax
(707) 441-1253
NPI assigned
Apr 23, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X 104793 CA Primary

Addresses

Primary practice location

2200 Tydd St
Eureka, CA 95501-1284

Mailing address

1275 8TH St
Arcata, CA 95521-5770
Phone (707) 826-8633

Other practice location 1

1431 Ambrosini Ln
Ferndale, CA 95536-9772
Phone (415) 531-4905

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240109002754 CA Practitioner - Clinical Social Worker 7719338292 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Open Door Community Health CentersGroup PAC ID 9436067485, 113 clinicians

Practice addresses (Care Compare)

2200 Tydd St
Eureka, CA 95501-1284
Phone (707) 441-1624

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Open Door Community Health Centers CurrentSince Nov 13, 2023 Accepting new patients
Open Door Community Health Centers CurrentSince Nov 13, 2023 Accepting new patients

Locations

1275 8th St
Arcata, CA 95521

550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636

2200 Tydd St
Eureka, CA 95501
Phone (707) 269-7051

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1013234418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 8TH ST",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955215770",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 TYDD ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955011284",
            "telephone_number": "707-441-1624",
            "fax_number": "707-441-1253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1431 Ambrosini Ln",
            "address_purpose": "LOCATION",
            "city": "Ferndale",
            "state": "CA",
            "postal_code": "955369772",
            "country_code": "US",
            "telephone_number": "415-531-4905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOMLIN",
        "first_name": "BRANDON",
        "middle_name": "EDWARD",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-23",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "104793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.