Active NPI
Pamela Zane Brunner, PHD
- Psychologist
- Santa Rosa, CA
National Provider Identifier
1780023150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 25711
- Practice address
- 124 Wikiup Dr
Santa Rosa, CA 95403-7700 - Phone
- (707) 484-0319
- NPI assigned
- Jun 19, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 25711 | CA | Primary |
Addresses
Primary practice location
124 Wikiup Dr
Santa Rosa, CA 95403-7700
Mailing address
124 Wikiup Dr
Santa Rosa, CA 95403-7700
Phone (707) 484-0319
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130903000639 | CA | Practitioner - Clinical Psychologist | 5799928115 | Practice locations: Santa Rosa, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
112 Roweland CT
Santa Rosa, CA 95403-3136
Phone (707) 484-0319
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 25711 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468540800000",
"number": "1780023150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 WIKIUP DR",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954037700",
"telephone_number": "707-484-0319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 WIKIUP DR",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954037700",
"telephone_number": "707-484-0319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNNER",
"first_name": "PAMELA",
"middle_name": "ZANE",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-19",
"last_updated": "2016-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 25711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.
- 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.