Madelyn E Brotnow, PA - C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

010960 Issued in IL

Practice address

1401 E State St
Rockford, IL 61104-2315

Phone

(779) 696-4400

NPI assigned

Dec 30, 2024

Last updated

Dec 30, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Rockford Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Rockford, IL
  • NPI 1639876634
  Medicare reassignment

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

{
    "created_epoch": "1735516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1174331680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "837 DEERING CT",
            "city": "WEST CHICAGO",
            "state": "IL",
            "postal_code": "601854956",
            "telephone_number": "630-749-8642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042315",
            "telephone_number": "779-696-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROTNOW",
        "first_name": "MADELYN",
        "middle_name": "E",
        "credential": "PA - C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "010960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colin Michael Broderick, PA-C
• Abrianna Nicole Brodnicki, FNP
• Amy L Brodsky, MD
• Ebony Brooks, RPH
• Ashley Broom, LPC
• Ann L. Broughton, M.A.
• Angela Brown, N.P
• Bryce Brown
• Cynthia A. Brown, LCSW
• Jennifer Ann Brown

• Physician Assistant in Rockford, IL
• Providers in Rockford, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.

Verify at the official NPI Registry.