Individual provider Active NPI

Sandra L Branton, EDD

  • Psychologist
  • South Lake Tahoe, CA
National Provider Identifier
1063524312
Registry record updated Sep 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY11992 Issued in CA
Practice address
870 Emerald Bay Rd
Suite 305
South Lake Tahoe, CA 96150-9403
Phone
(530) 541-5977
Fax
(530) 577-4686
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2009

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY11992 CA Primary
Psychologist 103T00000X PY0299 NV
Marriage & Family Therapist 106H00000X MFC18217 CA

Addresses

Primary practice location

870 Emerald Bay Rd
Suite 305
South Lake Tahoe, CA 96150-9403

Mailing address

PO Box 550547
South Lake Tahoe, CA 96155-0010
Phone (530) 541-5977

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
I20050323001357 CA Practitioner - Clinical Psychologist 9234185141 Practice locations: South Lake Tahoe, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of California, San Francisco School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

870 Emerald Bay Rd
Suite 301
South Lake Tahoe, CA 96150-6324
Phone (530) 541-5977

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MFC18217CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253232000000",
    "number": "1063524312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550547",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961550010",
            "telephone_number": "530-541-5977",
            "fax_number": "530-577-4686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 EMERALD BAY RD",
            "address_2": "SUITE 305",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961509403",
            "telephone_number": "530-541-5977",
            "fax_number": "530-577-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANTON",
        "first_name": "SANDRA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "EDD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2009-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY11992",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NV",
            "license": "PY0299",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC18217",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lake Tahoe, CA

Sources for this page

Verify at the official NPI Registry.