Antonius D Brandon, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY12281 Issued in CA

Practice address

5887 Brockton Ave
Riverside Psychiatric Medical Group Ste a
Riverside, CA 92506

Phone

(951) 275-8500

Fax

(951) 275-8560

NPI assigned

Sep 11, 2006

Last updated

Apr 29, 2008By the provider in NPPES

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: 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, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Riverside Psychiatric Medical GroupGroup PAC ID 8426956954, 8 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Riverside Psychiatric Medical Group

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Riverside, CA
  • NPI 1972691228
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1790889863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5887 BROCKTON AVE",
            "address_2": "RIVERSIDE PSYCHIATRIC MEDICAL GROUP STE A",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92506",
            "telephone_number": "951-275-8500",
            "fax_number": "951-275-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5887 BROCKTON AVE",
            "address_2": "RIVERSIDE PSYCHIATRIC MEDICAL GROUP STE A",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92506",
            "telephone_number": "951-275-8500",
            "fax_number": "951-275-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDON",
        "first_name": "ANTONIUS",
        "middle_name": "D",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY12281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Jon Brand, MD
• Amanda Nicole Brandenburg
• Savannah Marie Brandenburger
• John Brandom
• Brandon Mansouri Marriage & Family Therapist, Inc.
• K'la Brandon
• Mary Brantley
• Barbara Parvinder Brar, MD
• Bobby Karandeep Singh Brar
• Harbinder S Brar, M.D. INC

• Clinical Neuropsychologist in Riverside, CA
• Providers in Riverside, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.