Derald E Brackmann, MD

Primary specialty

Otology & Neurotology PhysicianTaxonomy code 207YX0901X

License

G11124 Issued in CA

Practice address

2100 W 3Rd St Ste 111
Los Angeles, CA 90057-1999

Phone

(213) 483-9930

Fax

(213) 483-0905

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

No

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: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

OtolaryngologyAlso: Neurology

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1962

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pih Health PhysiciansGroup PAC ID 8426951328, 616 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

78.61 of 100Reported as group

Quality

58.7

Improvement activities

40

Cost

75.08

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: deraldbrackmann@pihh.allscriptsdirect.net

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.

• Pih Health Physicians

  • Family Medicine Physician
  • Whittier, CA
  • NPI 1609233899
  Medicare reassignment Care Compare group NPD
• House Ear Clinic Inc

  • Otolaryngology Physician
  • Orange, CA
  • NPI 1679592737
  Medicare reassignment NPD
• House Ear Clinic Inc

  • Otolaryngology Physician
  • Los Angeles, CA
  • NPI 1881624799
  NPD
• Pih Health Physicians

  • Anesthesiology Physician
  • Downey, CA
  • NPI 1447931506
  NPD
• Pih Health Physicians

  • Family Medicine Physician
  • Whittier, CA
  • NPI 1588829006

  Otology & Neurotology

  NPD
• Pih Health Good Samaritan Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1508859323
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378166400000",
    "number": "1508876699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 W 3RD ST STE 111",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571999",
            "telephone_number": "213-483-9930",
            "fax_number": "213-483-0905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W 3RD ST STE 111",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571999",
            "telephone_number": "213-483-9930",
            "fax_number": "213-483-0905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKMANN",
        "first_name": "DERALD",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2013-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "CA",
            "license": "G11124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G111240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Margaret Brace, R.N., PH.D
• Michael Brachman, MD
• Aneisha Brackens
• Maureen Anne Brackey, MSW, CDVC
• Caleb Thomas Brackin, FNP
• De Andre E Bracy
• Ishmael Angelo Bracy
• Ashley Marie Bradbury, MT
• Braddock Dialysis LLC
• Clarence Henry Braddock III, M.D.

• Otology & Neurotology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Otology & Neurotology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; 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.