NPIMap

Individual provider Active NPI

Corey Elizabeth Brom

  • Physician Assistant
  • Columbia, SC
National Provider Identifier
1174398986
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5055 Issued in SC
Practice address
120 Gateway Corporate Blvd
Columbia, SC 29203-9611
Phone
(803) 865-4500
NPI assigned
Nov 21, 2023
Last updated
Feb 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5055 SC Primary
Medical Physician Assistant 363AM0700X SC

Addresses

Primary practice location

120 Gateway Corporate Blvd
Columbia, SC 29203-9611

Mailing address

221 Riverview Ter
Lake Wylie, SC 29710-8964

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231220003944 SC Practitioner - Physician Assistant 6800246596 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apogee Medical Group South CarolinaGroup PAC ID 8921193020, 69 clinicians
South Carolina Group Services, LLCGroup PAC ID 1759525777, 19 clinicians

Practice addresses (Care Compare)

120 Gateway Corp Blvd
Columbia, SC 29203-9611
Phone (803) 865-4500

2000 Hospital Dr
Mount Pleasant, SC 29464-3764
Phone (843) 881-0100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.99 of 100Reported as group
Quality
81.65
Improvement activities
40
Cost
74.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5055SCMDSpeech-Language Pathologist

Organizations & group practices 2

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1700524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1174398986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 RIVERVIEW TER",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297108964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 GATEWAY CORPORATE BLVD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039611",
            "telephone_number": "803-865-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROM",
        "first_name": "COREY",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-21",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "5055",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.