Richard G Brake, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

14197 Issued in TX

Practice address

15321 San Pedro Ave Ste 102
San Antonio, TX 78232-3712

Phone

(210) 587-6177

Fax

(210) 587-6178

NPI assigned

Oct 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Clinical Psychologist

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• BCFS Health and Human Services

  • Case Management Agency
  • Laredo, TX
  • NPI 1689751596
  NPD (past)

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413331200000",
    "number": "1205912086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15321 SAN PEDRO AVE STE 102",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782323712",
            "telephone_number": "210-587-6177",
            "fax_number": "210-587-6178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15321 SAN PEDRO AVE STE 102",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782323712",
            "telephone_number": "210-587-6177",
            "fax_number": "210-587-6178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAKE",
        "first_name": "RICHARD",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2014-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "14197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160425801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brain Based Rehab, PLLC
• Brain Changers, LLC (LearningRx)
• Brain Coach LLC
• Brain Sentinel Diagnostic Services
• Brainwork Speech and Rehab, PLLC
• Charles H Brakhage, PA-C
• Michelle Brakhage
• Laurie Louise Bram, COTA
• James Walter Bramblett II, D.C.
• Michelle Brame Gunnin, LPC

• Psychologist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.