Brandon Dederich, MPT, MS, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

26864 Issued in CA

Practice address

144 W Los Angeles Ave Ste 110
Moorpark, CA 93021-4218

Phone

(805) 552-1915

Fax

(805) 552-1991

NPI assigned

Mar 14, 2006

Last updated

Aug 1, 2022By 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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Seal Beach Physical Therapy Inc.Group PAC ID 3476782137, 3 clinicians

Xcelerate Physical Therapy Inc.Group PAC ID 4385621374, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Xcelerate Physical Therapy Inc.

  • Physical Therapist
  • Thousand Oaks, CA
  • NPI 1306814124
  Medicare reassignment Care Compare group NPD Authorized official
• Seal Beach Physical Therapy Inc.

  • Physical Therapist
  • Seal Beach, CA
  • NPI 1316262983
  Medicare reassignment Care Compare group NPD
• Xcelerate Physical Therapy Inc.

  • Physical Therapist
  • Moorpark, CA
  • NPI 1952444812
  NPD Authorized official
• Xcel Physical Therapy & Wellness Center PC

  • Physical Therapy Clinic/Center
  • Moorpark, CA
  • NPI 1932912094

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1912976853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 W LOS ANGELES AVE STE 110",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930214218",
            "telephone_number": "805-552-1915",
            "fax_number": "805-552-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 W LOS ANGELES AVE STE 110",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930214218",
            "telephone_number": "805-552-1915",
            "fax_number": "805-552-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDERICH",
        "first_name": "BRANDON",
        "credential": "MPT, MS, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "26864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "264440100",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP#",
            "identifier": "ZZZ082282",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD INDIVIDUAL",
            "identifier": "OPT268640",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• County of Ventura (Moorpark Family Medical Group / Moorpark College)
• Ivy Chereze Cruz, FNP-BC
• Kaitlyn Danner, MD
• Sergio De la Rosa
• Kristina Dea, OD
• Kimberly Dee, PHARMD
• Darcy Demmon, PPS
• Samuel Austin Dominguez, BA
• Don R Stanley Jr DC & Wendy Womack Stanley DC (Moorpark Chiropractic)
• Dorfman and Gershfeld a Professional Corporation

• Physical Therapist in Moorpark, CA
• Providers in Moorpark, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.