Active NPI
Johana Kashiwa Brakeley, M.D.
- Developmental - Behavioral Pediatrics Physician
- Middlebury, VT
National Provider Identifier
1780786376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental - Behavioral Pediatrics Physician
- License
- 0420006226
- Practice address
- 5 South St
Middlebury, VT 05753-1319 - Phone
- (802) 388-1002
- Fax
- (802) 388-1004
- NPI assigned
- Sep 2, 2006
- 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 |
|---|---|---|---|---|
| Developmental - Behavioral Pediatrics Physician | 2080P0006X | 0420006226 | VT | Primary |
Addresses
Primary practice location
5 South St
Middlebury, VT 05753-1319
Mailing address
5 South St
Middlebury, VT 05753-1319
Phone (802) 388-2194
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005148 | Medicaid | VT | |
| 26V004 | Other | VT | MVP INSURANCE |
| 481306 | Other | VT | CIGNA INSURANCE |
| 0005148 | Other | VT | BLUE CROSS & BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0420006226 | VT | MD | Developmental - Behavioral Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780786376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 SOUTH ST",
"city": "MIDDLEBURY",
"state": "VT",
"postal_code": "057531319",
"telephone_number": "802-388-2194",
"fax_number": "802-388-1004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 SOUTH ST",
"city": "MIDDLEBURY",
"state": "VT",
"postal_code": "057531319",
"telephone_number": "802-388-1002",
"fax_number": "802-388-1004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAKELEY",
"first_name": "JOHANA",
"middle_name": "KASHIWA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0006X",
"taxonomy_group": "",
"desc": "Pediatrics, Developmental - Behavioral Pediatrics",
"state": "VT",
"license": "0420006226",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005148",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP INSURANCE",
"identifier": "26V004",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA INSURANCE",
"identifier": "481306",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "0005148",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middlebury, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.