Active NPI
Bradley J Engwall, MD
- Child & Adolescent Psychiatry Physician
- Berkeley, CA
National Provider Identifier
1366588261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- A62477
- Practice address
- 2020 Milvia St
Ste 450
Berkeley, CA 94704-2685 - Phone
- (510) 559-1819
- Fax
- (510) 559-1819
- NPI assigned
- Jan 29, 2007
- 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 | A62477 | CA | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | A62477 | CA | Primary |
Addresses
Primary practice location
2020 Milvia St
Ste 450
Berkeley, CA 94704-2685
Mailing address
2020 Milvia St
Ste 450
Berkeley, CA 94704-2685
Phone (510) 559-1819
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2021 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A62477 | CA | MD | Child & Adolescent Psychiatry Physician |
| 62477 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389139200000",
"number": "1366588261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 MILVIA ST",
"address_2": "STE 450",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947042685",
"telephone_number": "510-559-1819",
"fax_number": "510-559-1819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 MILVIA ST",
"address_2": "STE 450",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947042685",
"telephone_number": "510-559-1819",
"fax_number": "510-559-1819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENGWALL",
"first_name": "BRADLEY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2014-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A62477",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CA",
"license": "A62477",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.