Gwen Marie Broz, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

73319 Issued in MA

Practice address

46 N Main St
W Brookfield, MA 01585

Phone

(508) 867-8977

Fax

(508) 867-7361

NPI assigned

Oct 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DACACA

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.

• West Brookfield Family Practice

  • Family Medicine Physician
  • West Brookfield, MA
  • NPI 1205032463
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013091669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1044",
            "city": "W BROOKFIELD",
            "state": "MA",
            "postal_code": "01585",
            "telephone_number": "508-867-8977",
            "fax_number": "508-867-7361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 N MAIN ST",
            "city": "W BROOKFIELD",
            "state": "MA",
            "postal_code": "01585",
            "telephone_number": "508-867-8977",
            "fax_number": "508-867-7361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROZ",
        "first_name": "GWEN",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "73319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9787364",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brookhaven Rest Home
• Brookhaven Rest Home
• Jessica Lynn McCann
• Wickaboag Family Chiropractic Inc

• Family Medicine Physician in W Brookfield, MA
• Providers in W Brookfield, MA by specialty
• Family Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.