NPIMap

Individual provider Active NPI

Brian Robert Baucom, PH.D.

  • Psychologist
  • Los Angeles, CA
National Provider Identifier
1982868378
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSB 33264 Issued in CA
Practice address
6310 San Vicente Blvd
Suite 350
Los Angeles, CA 90048-5426
Phone
(310) 625-9267
NPI assigned
Jul 15, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSB 33264 CA Primary

Addresses

Primary practice location

6310 San Vicente Blvd
Suite 350
Los Angeles, CA 90048-5426

Mailing address

6310 San Vicente Blvd
Suite 350
Los Angeles, CA 90048-5426
Phone (310) 625-9267

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bbaucom683796@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240409001393 UT Practitioner - Clinical Psychologist 4688012735 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSB 33264CAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Behavioral Health Services CurrentSince Feb 28, 2024 Accepting new patients
University of Utah Pediatric Behavioral Health Services Current Accepting new patients
University of Utah Behavioral Health Services CurrentSince Feb 28, 2024 Accepting new patients
University of Utah Behavioral Health Services CurrentSince Feb 28, 2024 Accepting new patients
University of Utah Behavioral Health Services Current Accepting new patients
University of Utah Pediatric Behavioral Health Services CurrentSince Feb 28, 2024 Accepting new patients

Locations

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

81 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 662-5700

501 S Chipeta Way
Slc, UT 84108
Phone (801) 581-7951

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1982868378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6310 SAN VICENTE BLVD",
            "address_2": "SUITE 350",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485426",
            "telephone_number": "310-625-9267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6310 SAN VICENTE BLVD",
            "address_2": "SUITE 350",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485426",
            "telephone_number": "310-625-9267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUCOM",
        "first_name": "BRIAN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-15",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSB 33264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bbaucom683796@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.