NPIMap

Individual provider Active NPI

Brazell H Carter, M.D.

  • Specialist
  • Richmond, CA
National Provider Identifier
1578736328
Registry record updated Apr 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A030396 Issued in CA
Practice address
2600 Macdonald Ave
Richmond, CA 94804-1826
Phone
(510) 236-8484
Fax
(510) 235-8650
NPI assigned
Apr 11, 2008
Last updated
Apr 11, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A030396 CA Primary

Addresses

Primary practice location

2600 Macdonald Ave
Richmond, CA 94804-1826

Mailing address

2600 Macdonald Ave
Richmond, CA 94804-1826
Phone (510) 236-8484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080429000329 CA Practitioner - Internal Medicine 4284712449 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Meharry Medical College School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
KND Development 59 LLCGroup PAC ID 3678602802, 176 clinicians

Practice addresses (Care Compare)

2800 Benedict Dr
San Leandro, CA 94577-6840
Phone (510) 357-8300

550 N Monterey Ave
Ontario, CA 91764-3318
Phone (909) 391-0333

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A030396CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifelong Medical Care CurrentSince Sep 2, 2018 Accepting new patients
KND Development 59, LLC CurrentSince Oct 1, 2014 Accepting new patients
Lifelong Medical Care Single Specialty CurrentSince Sep 2, 2018 Accepting new patients
KND Development 59 LLC Single Specialty Current Accepting new patients
KND Development 59, LLC CurrentSince Oct 1, 2014 Accepting new patients
California Pacific Medical Group, Inc. Past Accepting new patients

Locations

2344 6th St
Berkeley, CA 94710
Phone (510) 981-3203

10700 MacArthur Blvd
Ste 14B
Oakland, CA 94605
Phone (510) 563-4300

550 N Monterey Ave
Ontario, CA 91764
Phone (909) 629-2290

2800 Benedict Dr
San Leandro, CA 94577
Phone (510) 357-8300

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: bcarter293854@direct.ochin.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shields Nursing CenterEl Cerrito, CA, CCN 555364 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2003
Jun 1, 2003
Vale Healthcare CenterSan Pablo, CA, CCN 056389 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 21, 2011
Feb 21, 2011

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1578736328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 MACDONALD AVE",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948041826",
            "telephone_number": "510-236-8484",
            "fax_number": "510-235-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 MACDONALD AVE",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948041826",
            "telephone_number": "510-236-8484",
            "fax_number": "510-235-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTER",
        "first_name": "BRAZELL",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-11",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A030396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, CA

Sources for this page

Verify at the official NPI Registry.