Brock Kenneth Kilbourne, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY10467 Issued in CA

Practice address

2181 S El Camino Real Ste 307
Oceanside, CA 92054-6288

Phone

(760) 722-4233

Fax

(760) 722-4232

NPI assigned

Mar 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• El Camino Psychology Services. PC

  • Clinical Psychologist
  • Oceanside, CA
  • NPI 1932233178
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1467586701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29821 VALLE OLVERA ST",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925911638",
            "telephone_number": "951-676-4949",
            "fax_number": "951-676-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2181 S EL CAMINO REAL STE 307",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920546288",
            "telephone_number": "760-722-4233",
            "fax_number": "760-722-4232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILBOURNE",
        "first_name": "BROCK",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY10467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY10467",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Kidde
• Susan Denise Kidman, LVN
• Kids Smile Pediatric Dentistry
• Heather R Kiffe, LCSW
• Lauren Kikumoto, OTR/L
• Susan Kilby, RN
• Robert W Killebrew, DPT
• Jaesung Kim, DMD
• Jessica Min Kim, DPT
• Ki Wan Kim, D.D.S.

• Clinical Psychologist in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.