Active NPI
Daniel Brockett, M.D.
- Psychiatry Physician
- San Diego, CA
National Provider Identifier
1609001718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A84077
- Practice address
- 1350 Columbia St
San Diego, CA 92101-3454 - Phone
- (858) 480-1044
- NPI assigned
- May 18, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A84077 | CA | Primary |
Addresses
Primary practice location
1350 Columbia St
San Diego, CA 92101-3454
Mailing address
1350 Columbia St
San Diego, CA 92101-3454
Phone (858) 480-1044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 17, 2015 through Jun 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458864000000",
"number": "1609001718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 COLUMBIA ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921013454",
"telephone_number": "858-480-1044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 COLUMBIA ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921013454",
"telephone_number": "858-480-1044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKETT",
"first_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-18",
"last_updated": "2016-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A84077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.