Individual provider Active NPI

Jason Thomas Brandlin

  • Physician Assistant
  • Pomona, CA
National Provider Identifier
1366174922
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
61724 Issued in CA
Practice address
309 E 2ND St
Pomona, CA 91766-1854
Phone
(909) 623-6116
NPI assigned
Jun 30, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 61724 CA Primary

Addresses

Primary practice location

309 E 2ND St
Pomona, CA 91766-1854

Mailing address

309 E 2ND St
Pomona, CA 91766-1854

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230217001215 CA Practitioner - Physician Assistant 4284006313 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

160 E Artesia St
Pomona, CA 91767-2921
Phone (909) 596-4346

3630 E Imperial Hwy
Lynwood, CA 90262-2609
Phone (310) 900-8900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.24 of 100Reported as group
Quality
62.82
Improvement activities
40
Cost
83.93

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
61724CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sports Medicine and Orthopaedic Institute CurrentSince Jan 8, 2024 Accepting new patients
Prime Healthcare Services - San Dimas LLC CurrentSince Jan 8, 2024 Accepting new patients
Cep America - California CurrentSince Feb 15, 2023 Accepting new patients
Cep America - California CurrentSince Feb 15, 2023 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

5000 San Bernardino St
Montclair, CA 91763
Phone (909) 625-4111

160 E Artesia St
Ste 255
Pomona, CA 91767
Phone (909) 620-0900

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

999 San Bernardino Rd
Upland, CA 91786
Phone (909) 920-4841

Interoperability endpoints

  • Direct secure messaging: jason.brandlin.1@20474.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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": "1656547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1366174922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 E 2ND ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E 2ND ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661854",
            "telephone_number": "909-623-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDLIN",
        "first_name": "JASON",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-30",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "61724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.