Active NPI
Paul E Bracke
- Psychologist
- Oakland, CA
National Provider Identifier
1295826980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY10435
- Practice address
- 6239 College Avenue
Ste 204
Oakland, CA 94618-1329 - Phone
- (510) 287-9190
- NPI assigned
- Sep 27, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY10435 | CA | Primary |
Addresses
Primary practice location
6239 College Avenue
Ste 204
Oakland, CA 94618-1329
Mailing address
6239 College Avenue
Ste 204
Oakland, CA 94618-1329
Phone (510) 287-9190
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050209001086 | CA | Practitioner - Clinical Psychologist | 8527019264 | Practice locations: San Leandro, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Stanford University School of Medicine, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1395 Daily Dr
San Leandro, CA 94577-6339
Phone (510) 326-9567
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10435 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353369600000",
"number": "1295826980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6239 COLLEGE AVENUE",
"address_2": "STE 204",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946181329",
"telephone_number": "510-287-9190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6239 COLLEGE AVENUE",
"address_2": "STE 204",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946181329",
"telephone_number": "510-287-9190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKE",
"first_name": "PAUL",
"middle_name": "E",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2012-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY10435",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; 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.