Broc Hammon, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

019.032972 Issued in IL

Practice address

310 W Losey St
Scott Afb, IL 62225-5250

Phone

(618) 256-9355

Fax

(618) 256-7018

NPI assigned

Aug 14, 2014

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 13, 2023 through Sep 13, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Northern Nevada Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Reno, NV
  • NPI 1871152884

  Oral and Maxillofacial Surgery

  NPD (past)
• Renown Regional Medical Center

  • General Acute Care Hospital
  • Reno, NV
  • NPI 1124098421
  NPD (past)

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

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644883200000",
    "number": "1154720167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "94535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-9355",
            "fax_number": "618-256-7018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMMON",
        "first_name": "BROC",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-14",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019.032972",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "9047230-9921",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley C Gullixson, D.O.
• Marcel L Gustin, PA-C
• Alyssa Rose Hall
• Stefan Christopher Hamelin, M.D.
• David Hammiel, LCSW
• Evelyn Brito Harter, MA, CCC-SLP
• Relinda Denise Hayes, LCSW
• Deborah Leigh Henry, PA-C
• Seth Heying
• Helen M Horn, WHNP

• All providers in Scott Afb, IL
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.