Individual provider Active NPI

Thomas Kerwin Brassington, D.D.S.

  • General Practice Dentistry
  • La Mesa, CA
National Provider Identifier
1932113115
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
23426 Issued in CA
Practice address
8442 La Mesa Blvd
La Mesa, CA 91941
Phone
(619) 464-3636
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 23426 CA Primary

Addresses

Primary practice location

8442 La Mesa Blvd
La Mesa, CA 91941

Mailing address

8442 La Mesa Blvd
La Mesa, CA 91941
Phone (619) 464-3636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151217000864 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6800197740

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23426CAMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932113115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8442 LA MESA BLVD",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "91941",
            "telephone_number": "619-464-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8442 LA MESA BLVD",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "91941",
            "telephone_number": "619-464-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRASSINGTON",
        "first_name": "THOMAS",
        "middle_name": "KERWIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "23426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.