Brightline Medical Affiliates, PA

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

BRIGHTLINE MEDICAL AFFILIATES, PA

Practice address

400 Concar Dr
San Mateo, CA 94402-2681

Phone

(650) 456-5777

NPI assigned

Dec 29, 2021

Last updated

Jan 3, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Grodberg, MD

Title

Chief of Psychiatry

Phone

(917) 587-0024

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1640736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1871253062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CONCAR DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022681",
            "telephone_number": "650-456-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CONCAR DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022681",
            "telephone_number": "650-456-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHTLINE MEDICAL AFFILIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-29",
        "last_updated": "2023-01-03",
        "certification_date": "2022-10-11",
        "status": "A",
        "authorized_official_last_name": "GRODBERG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF OF PSYCHIATRY",
        "authorized_official_telephone_number": "917-587-0024",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Laurinda Bright
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• Brightline Medical Associates, PA (Brightline)
• Brightline Medical Associates, PA (Brightline)

• Adolescent and Children Mental Health Clinic/Center in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Adolescent and Children Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.