Beau Charles Brendley, PSY D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS018603 Issued in PA

Practice address

255 S 17TH St Ste 1010
Philadelphia, PA 19103-6210

Phone

(672) 319-5882

NPI assigned

Nov 15, 2011

Last updated

Sep 25, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Estadt Psychological Services LLCGroup PAC ID 6800107640, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dcp.beaubrendley@141748.advancedmd-direct.com

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.

• Estadt Psychological Services, LLC

  • Clinical Psychologist
  • Philadelphia, PA
  • NPI 1801288667
  Medicare reassignment Care Compare group NPD
• Springfield Psychological PC

  dba Associates of Springfield Psychological

  • Mental Health Counselor
  • Springfield, PA
  • NPI 1295705317
  NPD

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

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1447537766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 S 2ND ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191473415",
            "telephone_number": "267-231-9588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 S 17TH ST STE 1010",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191036210",
            "telephone_number": "672-319-5882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENDLEY",
        "first_name": "BEAU",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "PSY D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-15",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC006129",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS018603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Remy Bremner, MD
• Robert John Brenchak, M.D.
• Brendanmoor Therapy LLC
• Erica M Brendel, MD
• Katelyn Brendel, DO
• Jose Reynaldo Brenes
• Scott A Brenman, MD
• Amanda Elizabeth Brennan, CRNP
• Amy Brennan
• Brittany Trimble Brennan

• Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.

Verify at the official NPI Registry.