BRANDON DEDERICH (MPT, MS, ATC) – Physical Therapist, NPI 1912976853

BRANDON DEDERICH (MPT, MS, ATC) is a healthcare provider. based in Moorpark, California. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials MPT, MS, ATC. They hold a License No. 26864 (CA). The NPI Number for BRANDON DEDERICH (MPT, MS, ATC) is 1912976853

Main info

Male
26 Years Of Experience
Accepts Medicare Assignment
Name
BRANDON DEDERICH (MPT, MS, ATC)
NPI
1912976853
Phone
(805) 552-1915
Address
144 W LOS ANGELES AVE STE 110
Enumeration Date
14 March 2006
Last Update Date
1 August 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8053749900
Graduation Year
2000 (26 years ago)
PAC ID
6800873894
Group Practice PAC ID
4385621374
Professional Enrollment ID
I20040708000503
Address ID
CA913623445TH3262XBLVD501
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience64
Completeness75
Years active:20State licenses:1Digital endpointsOther names

9,449 PHYSICAL THERAPIST IN PRIVATE PRACTICE in CA

Provider Addresses for BRANDON DEDERICH (MPT, MS, ATC)

  • 144 W LOS ANGELES AVE STE 110

    MOORPARK, CA 930214218

    Phone: (805) 552-1915

    Fax: (805) 552-1991

    Type: Location

  • 3262, East Thousand Oaks Boulevard, Triunfo Corner, Thousand Oaks, Ventura County, California, 91362, United States

    STE 100

    THOUSAND OAKS, CA 913623446

    Phone: (805) 374-9900

    Fax: (805) 374-9910

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-07-08

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040708000503IPhysical Therapist In Private PracticeCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes2,12794$0
97140Therapy procedure using manual technique, each 15 minutes1,23487$0
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes1,09648$0
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care23049$0
97530Therapy procedure using functional activities15130$0
View full utilization report →

Insurance plans in this area (ZIP 93021)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4385621374View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeCA
Physical Therapist In Private PracticeCA

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Frequently asked questions

How do I look up BRANDON DEDERICH (MPT, MS, ATC) by NPI?
Use NPI 1912976853 when you need to reference BRANDON DEDERICH (MPT, MS, ATC) in forms, claims, or directories.
Is BRANDON DEDERICH (MPT, MS, ATC)'s NPI currently valid?
The extract we use shows BRANDON DEDERICH (MPT, MS, ATC) as active.
Does BRANDON DEDERICH (MPT, MS, ATC) list a primary specialty?
If you are matching referrals, note Physical Therapist for BRANDON DEDERICH (MPT, MS, ATC). Clinical services aligned with this taxonomy classification.
What location shows for BRANDON DEDERICH (MPT, MS, ATC)?
We surface Moorpark, California for BRANDON DEDERICH (MPT, MS, ATC) based on available NPPES addresses.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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