Judith Brandt, D O Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A6245 Issued in CA

Legal business name

JUDITH BRANDT, D O INC

Doing business as

Camino Family Medical Center
Western Sierra Medical Center

Practice address

3070 Camino Heights Dr
Suite B
Camino, CA 95709-9508

Phone

(530) 647-9762

Fax

(530) 647-1961

NPI assigned

Jun 21, 2007

Last updated

Oct 28, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Judith Brandt, DONPI 1750363966

Title

President

Phone

(530) 651-2000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Camino Family Medical Center Doing business as
• Western Sierra Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457557126. Details of each certification follow.

• CCN 058909 Rural health clinic · Active · Details

Rural health clinic certification: CCN 058909

Legal name

JUDITH BRANDT D O INC

Doing business as

CAMINO FAMILY MEDICAL CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 29, 2005

Last certification

Feb 3, 2016

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Dec 8, 1999 in CA

Enrollment address

3070 Camino Heights Dr B
Camino, CA 95709-9508

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Judith Brandt, DO, FAAFP

  • Family Medicine Physician
  • Camino, CA
  • NPI 1750363966

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Judith Brandt, DO, FAAFP

  • Family Medicine Physician
  • Camino, CA
  • NPI 1750363966
  Authorized official Same address or phone
• Alyssa Spencer, PA-C

  • Physician Assistant
  • Sacramento, CA
  • NPI 1285093898
  NPD (past)

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666915200000",
    "number": "1457557126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3070 CAMINO HEIGHTS DR",
            "address_2": "SUITE B",
            "city": "CAMINO",
            "state": "CA",
            "postal_code": "957099508",
            "telephone_number": "530-647-9762",
            "fax_number": "530-647-1961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3070 CAMINO HEIGHTS DR",
            "address_2": "SUITE B",
            "city": "CAMINO",
            "state": "CA",
            "postal_code": "957099508",
            "telephone_number": "530-647-9762",
            "fax_number": "530-647-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDITH BRANDT, D O INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A",
        "authorized_official_last_name": "BRANDT",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "530-651-2000",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A6245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM08909F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camino Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western Sierra Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western Sierra Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lillyan Garewal, SUDRC 20850
• Renaee Gautier
• Kari Lynn Herbert, CADC-I
• Chastity Helena Hollis
• Dion Holm, RADT-I
• Kaylee J Caldwell (Branch & Bloom Speech Therapy)
• Pamela Kay Laurie
• Lauren Liuzzi
• Lynette Rowe Physical Therapy
• Thomas John McCoin, P.T.

• Family Medicine Physician in Camino, CA
• Providers in Camino, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.