Taeja Broadwater, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

MAO55689 Issued in PA

Practice address

Geisinger Medical Ctr
100 North Academy Drive
Danville, PA 17822-0001

Phone

(570) 271-5555

NPI assigned

May 18, 2009

Last updated

Sep 27, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carbon Health Medical Group of Florida PAGroup PAC ID 3274947304, 55 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: taeja.broadwater.1@31156.direct.athenahealth.com
• Direct secure messaging: taeja.broadwater.1@8363.direct.athenahealth.com
• Direct secure messaging: taeja.broadwater.1@9635.direct.athenahealth.com

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.

• Carbon Health Medical Group of Florida PA

  • Urgent Care Clinic/Center
  • Austin, TX
  • NPI 1477155331
  Medicare reassignment Care Compare group NPD
• Carbon Health Medical Group of Florida PA

  • Urgent Care Clinic/Center
  • Oro Valley, AZ
  • NPI 1396317079
  NPD

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

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380240000000",
    "number": "1114152329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 CLIFTON DR",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178153083",
            "telephone_number": "304-673-9476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GEISINGER MEDICAL CTR",
            "address_2": "100 NORTH ACADEMY DRIVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178220001",
            "telephone_number": "570-271-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWATER",
        "first_name": "TAEJA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-18",
        "last_updated": "2013-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MAO55689",
            "primary": true
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "MD",
            "license": "R185137",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenda Lou Brink, LSW
• Danielle Rachel Briskey, PA-C
• Chelsea L Britto, PA-C
• Amilynn Britton
• John Britton
• Bradley Eugene Brocious, D.O.
• Alessandra Brofferio, MD
• Michael C Brogna, M.D.
• Amy Lynne Brokenshire, PHARMD
• Ann Erin Brokenshire, DMD

• Surgical Physician Assistant in Danville, PA
• Providers in Danville, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; 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.
• 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.