Ekaterina Shatalova Broome, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

11880 Bird Rd Ste 101
Miami, FL 33175-3573

Phone

(786) 315-5925

NPI assigned

Mar 20, 2023

Last updated

Jul 5, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ekaterina Shatalova Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1184326738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11880 BIRD RD STE 101",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331753573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11880 BIRD RD STE 101",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331753573",
            "telephone_number": "786-315-5925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOME",
        "first_name": "EKATERINA",
        "middle_name": "SHATALOVA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EKATERINA",
            "last_name": "SHATALOVA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Matthew Brooks, DO
• Nikia S Brooks
• Sarah Brooks
• Velma Brooks
• Zachary David Brooks, PT, DPT
• Jeffrey P Brosco, MD, PHD
• Aramis Brossard Neyra, BS
• Alexander Brosseau
• Wayne J Broth, MD
• Brothers Pharmacy and Discount LLC

• Student in an Organized Health Care Education/Training Program in Miami, FL
• Providers in Miami, FL by specialty
• Student in an Organized Health Care Education/Training Program in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.