Jody Edwin Debruin, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

21895 Issued in CA

Practice address

10333 El Camino Real
Atascadero, CA 93422-5808

Phone

(805) 468-2000

Fax

(805) 468-6011

NPI assigned

Oct 9, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Joe Edwin Debruin Professional name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Blue Sky Psychology Group IncGroup PAC ID 4284155342, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Blue Sky Psychology Group, Inc.

  • Clinical Psychologist
  • Atascadero, CA
  • NPI 1710782842

  CA, Clinical

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373846400000",
    "number": "1760633523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 9TH ST",
            "address_2": "ROOM 150 FISCAL ALLOCATIONS AND ESTIMATES UNIT",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958146414",
            "telephone_number": "916-651-9475",
            "fax_number": "916-651-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10333 EL CAMINO REAL",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934225808",
            "telephone_number": "805-468-2000",
            "fax_number": "805-468-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBRUIN",
        "first_name": "JODY",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-09",
        "last_updated": "2013-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "21895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOE",
            "last_name": "DEBRUIN",
            "middle_name": "EDWIN",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Dawson Individual and Family Counseling Inc.
• Jessica Marie Dawson, LMFT
• Sonnet Jane Daymont
• Dayna Nelson, PSYD Family Psychology, a Professional Corporation
• Joshua Cylde Deane, MD
• Lynsey Jane Decou
• Arron Dehod, PSYD
• Saloumeh Fay Del Vecchio, LMFT
• Johann Justiniano Dela Paz, PT
• Joanna Delgado

• All providers in Atascadero, CA
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.