Jason James Brouwer, PH.D.
Individual provider Active NPI Clinical Psychologist · Maumee, OH
NPI 1992080451 · NPPES record last updated Oct 17, 2011
Key facts
- NPI
- 1992080451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 6837 (OH)
- Practice address
- 135 Chesterfield LN
Suite 200
Maumee, OH 43537-4314 - Phone
- (419) 578-7273
- NPI assigned
- Oct 17, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
135 Chesterfield LN
Suite 200
Maumee, OH 43537-2299
5565 Airport Hwy
Suite 200
Toledo, OH 43615-7379
Phone (419) 578-7273
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130614000558 | OH | Practitioner - Clinical Psychologist | 2567601966 | Practice locations: Toledo, OH |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 5 Stones Therapy and Wellness | Clinical | Past |
Accepting new patients |
| Harbor | Clinical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6837 | OH | Yes |
Addresses
Primary practice location
135 Chesterfield LN
Suite 200
Maumee, OH 43537-4314
Mailing address
135 Chesterfield LN
Suite 200
Maumee, OH 43537-4314
Phone (419) 578-7273
Other providers in Maumee, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.