Brendon Douglas Brockmann, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A135079 Issued in CA

Practice address

2085 Rustin Ave Ste 2
Riverside, CA 92507

Phone

(951) 509-8200

Fax

(951) 358-6622

NPI assigned

Mar 26, 2013

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

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1679815765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 RUSTIN AVE STE 2",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072498",
            "telephone_number": "951-509-8200",
            "fax_number": "951-358-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2085 RUSTIN AVE STE 2",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92507",
            "telephone_number": "951-509-8200",
            "fax_number": "951-358-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMANN",
        "first_name": "BRENDON",
        "middle_name": "DOUGLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-26",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A135079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Brletich
• Edwin Charles Broadnax
• Frances Adele Brobst, BHS II
• Mireya Elizabeth Brocatto-Keck, LMFT
• Ronny Angeline Brock
• Lynne M Brockmeier
• Brockton Dental X-Ray Lab., Inc.
• Brockton Endoscopy Surgery Center LP
• Brockton Investments & Associates, LLC
• Brockton Surgical Center

• Psychiatry Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.