Active NPI
Jason Brandt, PH.D.
- Clinical Psychologist
- Baltimore, MD
National Provider Identifier
1922065580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 01604
- Practice address
- 600 N Wolfe St
Baltimore, MD 21287-0005 - Phone
- (410) 955-5104
- NPI assigned
- Apr 27, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 01604 | MD | Primary |
Addresses
Primary practice location
600 N Wolfe St
Baltimore, MD 21287-0005
Mailing address
PO Box 64260
Baltimore, MD 21264-4260
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 448254900 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2021 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01604 | MD | MD | Foot & Ankle Surgery Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383523200000",
"number": "1922065580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 64260",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212644260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N WOLFE ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212870005",
"telephone_number": "410-955-5104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANDT",
"first_name": "JASON",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2013-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "01604",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "448254900",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.