NPIMap

Organization Active NPI

Brain and Behavioral Associates, PC

  • Psychologist
  • Albuquerque, NM
National Provider Identifier
1467747477
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
0880 Issued in NM
Legal business name
BRAIN AND BEHAVIORAL ASSOCIATES, PC
Practice address
1300 Central Ave SW
Albuquerque, NM 87102-2805
Phone
(505) 243-0335
Fax
(505) 216-2623
NPI assigned
Jun 17, 2011
Last updated
Oct 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

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

Authorized official

Name
Dr. Rex Eugene Jung, PH.DNPI 1801802558
Title
Owner
Phone
(505) 918-0066

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 0880 NM Primary

Addresses

Primary practice location

1300 Central Ave SW
Albuquerque, NM 87102-2805

Mailing address

1300 Central Ave SW
Albuquerque, NM 87102-2805
Phone (505) 243-0335

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111116000045 NM Part B Supplier - Clinic/Group Practice 2365616018 Receives reassigned benefits from 4 practitioners
Practice locations: Albuquerque, NM

National Provider Directory

National Provider Directory

Locations

1300 Central Ave SW
Albuquerque, NM 87102
Phone (505) 243-0335

801 University Blvd SE
Ste 202
Albuquerque, NM 87106
Phone (505) 272-7036

851 University Blvd SE
Ste 200
Albuquerque, NM 87106
Phone (505) 918-0066

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1308268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602460800000",
    "number": "1467747477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 CENTRAL AVE SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022805",
            "telephone_number": "505-243-0335",
            "fax_number": "505-216-2623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 CENTRAL AVE SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022805",
            "telephone_number": "505-243-0335",
            "fax_number": "505-216-2623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIN AND BEHAVIORAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-17",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "REX",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-918-0066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "NM",
            "license": "0880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.