Alexandrea Cromer Broom, NP-C
Individual provider Active NPI Family Nurse Practitioner · Laurens, SC
NPI 1003568320 · NPPES record last updated May 10, 2022
Key facts
- NPI
- 1003568320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 25725 (SC)
- Practice address
- 22580 Highway 76 E Ste 300
Laurens, SC 29360-8460 - Phone
- (864) 939-1070
- Fax
- (864) 939-1079
- NPI assigned
- Jan 19, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220225000518 | SC | Practitioner - Nurse Practitioner | 0042604696 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25725 | SC | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Self Medical Group | Current | Accepting new patients | |
| Self Medical Group | Current |
Accepting new patients | |
| Self Medical Group | Current |
Accepting new patients | |
| Self Medical Group | Past |
Accepting new patients |
Locations
75 Remittance Dr
Dept 6764
Chicago, IL 60675
22580 Highway 76 E
Ste 300
Laurens, SC 29360
Phone (864) 725-4183
2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 25725 | SC | Yes |
Addresses
Primary practice location
22580 Highway 76 E Ste 300
Laurens, SC 29360-8460
Mailing address
22580 Highway 76 E Ste 300
Laurens, SC 29360-8460
Phone (864) 939-1070
Other names
- Alexandrea Marie Cromer
Other providers in Laurens, SC
- Princess Boyd
- Timothy Bradberrry
- Myra Bradberry
- Christina Bravo
- Jessica Brooks
- Byron Hutchinson Brown
- Cecil Y Brown
- Kenya Michelle Brown
- Mekko Brown
- Catherine Joanne Brownlee
All providers in Laurens, SC · Family Nurse Practitioner in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2022. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.