NPIMap

Organization Active NPI

Patricia a Brotman M.D. a Professional Corp

  • Dermatology Physician
  • Chino Hills, CA
National Provider Identifier
1629003256
Registry record updated Aug 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
G69097 Issued in CA
Legal business name
PATRICIA A BROTMAN M.D. A PROFESSIONAL CORP
Practice address
15944 Los Serranos Country Club Dr Ste 180
Chino Hills, CA 91709-3990
Phone
(909) 393-3393
Fax
(909) 597-7009
NPI assigned
Jul 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2012

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

Authorized official

Name
Patricia Arden Brotman, M.D.NPI 1306871926
Title
President, Secretary, C.F.O
Phone
(909) 393-3393

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
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X G69097 CA Primary

Addresses

Primary practice location

15944 Los Serranos Country Club Dr Ste 180
Chino Hills, CA 91709-3990

Mailing address

15944 Los Serranos Country Club Dr Ste 180
Chino Hills, CA 91709-3990
Phone (909) 393-3393

Other identifiers 1

IdentifierTypeStateIssuer
00G690970MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040915001225 CA Part B Supplier - Clinic/Group Practice 4688641822 Receives reassigned benefits from 1 practitioner
Practice locations: Chino Hills, CA; Corona, CA

National Provider Directory

National Provider Directory

Locations

15944 Los Serranos Country Club Dr
Ste 180
Chino Hills, CA 91709
Phone (909) 393-3393

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345420800000",
    "number": "1629003256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15944 LOS SERRANOS COUNTRY CLUB DR STE 180",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917093990",
            "telephone_number": "909-393-3393",
            "fax_number": "909-597-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15944 LOS SERRANOS COUNTRY CLUB DR STE 180",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917093990",
            "telephone_number": "909-393-3393",
            "fax_number": "909-597-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICIA A BROTMAN M.D. A PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2012-08-20",
        "status": "A",
        "authorized_official_last_name": "BROTMAN",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "ARDEN",
        "authorized_official_title_or_position": "PRESIDENT, SECRETARY, C.F.O",
        "authorized_official_telephone_number": "909-393-3393",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G69097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G690970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2012; 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.