Active NPI
Nicolas Badre, M.D.
- Psychiatry Physician
- San Diego, CA
National Provider Identifier
1104112242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A123572
- Practice address
- 4142 Adams Ave # 103-211
San Diego, CA 92116-2592 - Phone
- (619) 796-1672
- NPI assigned
- Jun 28, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A123572 | CA | Primary |
Addresses
Primary practice location
4142 Adams Ave # 103-211
San Diego, CA 92116-2592
Mailing address
4142 Adams Ave # 103-211
San Diego, CA 92116-2592
Phone (619) 796-1672
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 15, 2021 through Jun 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A123572 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430006400000",
"number": "1104112242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4142 ADAMS AVE # 103-211",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921162592",
"telephone_number": "619-796-1672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4142 ADAMS AVE # 103-211",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921162592",
"telephone_number": "619-796-1672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BADRE",
"first_name": "NICOLAS",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-28",
"last_updated": "2015-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A123572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.