Active NPI
Alexander Um Broyles, DO
- Internal Medicine Physician
- Jonesboro, AR
National Provider Identifier
1114774940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- STUDENT
- Practice address
- 4800 E Johnson Ave
Jonesboro, AR 72405-8413 - Phone
- (870) 936-1000
- NPI assigned
- Apr 30, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | STUDENT | WA | Primary |
Addresses
Primary practice location
4800 E Johnson Ave
Jonesboro, AR 72405-8413
Mailing address
4009 Avalanche Ave
Yakima, WA 98908-2914
Phone (509) 952-8488
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240809002499 | AR | Order and Referring Only - Internal Medicine | 8921546839 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| STUDENT | WA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714608000000",
"number": "1114774940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4009 AVALANCHE AVE",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989082914",
"telephone_number": "509-952-8488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 E JOHNSON AVE",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724058413",
"telephone_number": "870-936-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROYLES",
"first_name": "ALEXANDER",
"middle_name": "UM",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-04-30",
"last_updated": "2024-05-02",
"certification_date": "2024-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "WA",
"license": "STUDENT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; 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.