Casey David Brodhead, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

26824 Issued in CA

Practice address

710 S Broadway
Suite 364
Walnut Creek, CA 94596-5294

Phone

(925) 295-2987

Fax

(925) 295-5226

NPI assigned

Mar 2, 2015

Last updated

Jan 3, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1174915086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 S BROADWAY",
            "address_2": "SUITE 364",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965294",
            "telephone_number": "925-295-2987",
            "fax_number": "925-295-5226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S BROADWAY",
            "address_2": "SUITE 364",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965294",
            "telephone_number": "925-295-2987",
            "fax_number": "925-295-5226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODHEAD",
        "first_name": "CASEY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-02",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "26824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "710 S Broadway",
            "city": "Walnut Creek",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945965294",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Briseno
• Lonnie Robert Bristow, M.D.
• Broadway Dmes LLC
• Broadways DME LLC
• Michele Anthony Brocato, PA-C
• Jennifer Brodie
• Trevor Brodsky-Brooks, M.D.
• Danica Nicole Brogdon
• Jared Brogdon
• Susan Gail Brogdon, LMFT

• Psychologist in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.