Individual provider Active NPI

Nicholas Patrick Brown, DO

  • Psychiatry Physician
  • Mount Shasta, CA
National Provider Identifier
1275939092
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
20A18162 Issued in CA
Practice address
214 E Lake St
Mount Shasta, CA 96067-2331
Phone
(530) 435-5048
NPI assigned
Nov 5, 2014
Last updated
Apr 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 125068485 IL
Psychiatry Physician 2084P0800X 20A18162 CA Primary

Addresses

Primary practice location

214 E Lake St
Mount Shasta, CA 96067-2331

Mailing address

214 E Lake St
Mount Shasta, CA 96067-2331
Phone (530) 435-5048

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201103002858 CA Practitioner - Psychiatry 7012204522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Col of Osteo Med of the Pacific at Lebanon, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nicholas Patrick Brown DOGroup PAC ID 8325458276, 2 clinicians

Practice addresses (Care Compare)

214 E Lake St
Mount Shasta, CA 96067-2331
Phone (530) 435-5048

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A18162CAMDPsychiatry Physician
18162CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Nicholas Patrick Brown, DO CurrentSince Sep 20, 2020 Accepting new patients

Locations

214 E Lake St
Mount Shasta, CA 96067
Phone (530) 435-5048

419 Chestnut St
Apt 3
Mount Shasta, CA 96067
Phone (530) 435-5048

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680480000000",
    "number": "1275939092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 E LAKE ST",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672331",
            "telephone_number": "530-435-5048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 E LAKE ST",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672331",
            "telephone_number": "530-435-5048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "NICHOLAS",
        "middle_name": "PATRICK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-05",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "125068485",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A18162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Shasta, CA

Sources for this page

Verify at the official NPI Registry.