Broadway Medical Treatment Center, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

CMD 06972 Issued in RI

Legal business name

BROADWAY MEDICAL TREATMENT CENTER, LLC

Practice address

1053 S Broadway
East Providence, RI 02914-4729

Phone

(401) 438-5551

Fax

(401) 438-7272

NPI assigned

Sep 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Peter George Brassard, M.D.NPI 1609877489

Title

Physician / Owner

Phone

(401) 438-5551

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter George Brassard, M.D.

  • Family Medicine Physician
  • East Providence, RI
  • NPI 1609877489

  RI

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1104010032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1053 S BROADWAY",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029144729",
            "telephone_number": "401-438-5551",
            "fax_number": "401-438-7272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1053 S BROADWAY",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029144729",
            "telephone_number": "401-438-5551",
            "fax_number": "401-438-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY MEDICAL TREATMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-04",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "BRASSARD",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "PHYSICIAN / OWNER",
        "authorized_official_telephone_number": "401-438-5551",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "RI",
            "license": "CMD 06972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Brandwood
• Peter George Brassard, M.D.
• Charles John Brex, MD
• Geana Brillon
• Shanan T Brissette, PT
• Amanda Brogna, FNP
• Clifford Bromberg, PHD
• Brown Medicine
• Brown Urology, Inc.
• Brown Vision Care, Inc

• All providers in East Providence, RI
• Family Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.