Jerica Nichole Brodhead, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10001219A Issued in IN

Practice address

7250 Clearvista Dr
Ste 355
Indianapolis, IN 46256-4692

Phone

(317) 621-5676

NPI assigned

Jun 6, 2011

Last updated

Dec 19, 2018By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Urology of Indiana, L.L.C.

  • Customized Equipment (DME)
  • Indianapolis, IN
  • NPI 1487734018
  NPD (past)
• Urology of Indiana, L.L.C.

  • Customized Equipment (DME)
  • Indianapolis, IN
  • NPI 1740360379
  NPD (past)

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

{
    "created_epoch": "1307318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1043504285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "address_2": "STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 CLEARVISTA DR",
            "address_2": "STE 355",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462564692",
            "telephone_number": "317-621-5676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODHEAD",
        "first_name": "JERICA",
        "middle_name": "NICHOLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-06",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001219A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1487680518",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000741701",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jill Marie Broderick, PHARMD
• Kristina P Broderick, PA-C
• Margaret Therese Broderick
• Thaddeus Broderick
• Lauren Elizabeth Brodeur
• Christopher John Brodowicz, DDS
• Erica Denelle Brodowski
• Emily C Brodowsky, MD
• Daniel A Brodsky, LMHC, LCAC
• Joshua Joseph Brody

• Physician Assistant in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.