Active NPI
Jerome Broad, CRNA
- Certified Registered Nurse Anesthetist
- Lancaster, PA
National Provider Identifier
1013976109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- RN326693L
- Practice address
- 555 N Duke St
Lancaster, PA 17602-2250 - Phone
- (717) 544-5511
- NPI assigned
- Mar 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN326693L | PA | Primary |
Addresses
Primary practice location
555 N Duke St
Lancaster, PA 17602-2250
Mailing address
555 N Duke St
Lancaster, PA 17602-2250
Phone (717) 544-5511
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4574637 | Other | PA | AETNA-NON HMO |
| 50055744 | Other | PA | CAPITAL BLUE CROSS |
| 0229988000 | Other | PA | INDEPENDENCE BLUE CROSS |
| 50055744 | Other | PA | KEYSTONE HEALTH PLAN CENTRAL |
| 1147543 | Other | PA | AETNA-HMO |
| P00233842 | Other | PA | RR MEDICARE |
| 000535767 | Other | PA | HIGHMARK |
| 106579 | Other | PA | GEISINGER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN326693L | PA | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301443200000",
"number": "1013976109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 N DUKE ST",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176022250",
"telephone_number": "717-544-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 N DUKE ST",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176022250",
"telephone_number": "717-544-5511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROAD",
"first_name": "JEROME",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-20",
"last_updated": "2011-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "PA",
"license": "RN326693L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA-NON HMO",
"identifier": "4574637",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50055744",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENCE BLUE CROSS",
"identifier": "0229988000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE HEALTH PLAN CENTRAL",
"identifier": "50055744",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA-HMO",
"identifier": "1147543",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00233842",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK",
"identifier": "000535767",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEISINGER",
"identifier": "106579",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.