Active NPI
Michael John Brase, MD
- Psychiatry Physician
- Indio, CA
National Provider Identifier
1225335771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G55669
- Practice address
- 47825 Oasis St
Indio, CA 92201-6950 - Phone
- (760) 863-8455
- NPI assigned
- Feb 18, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G55669 | CA | Primary |
| Child & Adolescent Psychiatry Physician | 2084P0804X | G55669 | CA |
Addresses
Primary practice location
47825 Oasis St
Indio, CA 92201-6950
Mailing address
47825 Oasis St
Indio, CA 92201-6950
Phone (760) 863-8455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G55669 | CA | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327363200000",
"number": "1225335771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47825 OASIS ST",
"city": "INDIO",
"state": "CA",
"postal_code": "922016950",
"telephone_number": "760-863-8455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "47825 OASIS ST",
"city": "INDIO",
"state": "CA",
"postal_code": "922016950",
"telephone_number": "760-863-8455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRASE",
"first_name": "MICHAEL",
"middle_name": "JOHN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-02-18",
"last_updated": "2012-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G55669",
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CA",
"license": "G55669",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indio, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.