Rodney Martin Brim, PH.D.
Individual provider Active NPI Psychologist · Smith River, CA
NPI 1851901045 · NPPES record last updated Aug 3, 2020
Key facts
- NPI
- 1851901045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 31897 (CA)
- Practice address
- 301 Nautical HTS
Smith River, CA 95567-9568 - Phone
- (541) 813-9173
- NPI assigned
- Aug 3, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1977
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
301 Nautical HTS
Smith River, CA 95567-9568
Phone (541) 813-9173
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200902000464 | CA | Practitioner - Clinical Psychologist | 2961829197 | Practice locations: Smith River, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31897 | CA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dov Wills | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 31897 | CA | |
| Psychologist | 103T00000X | 31897 | CA | Yes |
Addresses
Primary practice location
301 Nautical HTS
Smith River, CA 95567-9568
Mailing address
301 Nautical HTS
Smith River, CA 95567-9568
Phone (541) 813-9173
Other providers in Smith River, CA
- Carolyn L Arellanes
- Lana Ann Dreyfuss
- Sandra Alison Fachiol
- Chad Gagnon
- Wilmer Hechanova
- Branden Earl Hensel
All providers in Smith River, CA · Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.