NPIMap

Organization Active NPI

West Brookfield Family Practice

  • Family Medicine Physician
  • West Brookfield, MA
National Provider Identifier
1205032463
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
73319 Issued in MA
Legal business name
WEST BROOKFIELD FAMILY PRACTICE
Practice address
46 North Main St
West Brookfield, MA 01585
Phone
(508) 867-8977
Fax
(508) 867-7361
NPI assigned
Jun 25, 2007
Last updated
Jun 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Dr. Gwen Marie Broz, D.O.NPI 1013091669
Title
Doctor
Phone
(508) 867-8977

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 73319 MA Primary

Addresses

Primary practice location

46 North Main St
West Brookfield, MA 01585

Mailing address

46 North Main Street
West Brookfield, MA 01585-1044
Phone (508) 867-8977

Other identifiers 4

IdentifierTypeStateIssuer
154490OtherMADR JONES LICENSE
9787364MedicaidMA
219183OtherMADR WILSON LICENSE
73319OtherMADR BROZ LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090407000553 MA Part B Supplier - Clinic/Group Practice 2466509625 Receives reassigned benefits from 5 practitioners
Practice locations: W Brookfield, MA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D0938228West Brookfield Family Practice46 North Main St, West Brookfield, MA 01585Certificate of waiverJan 1, 2028

National Provider Directory

National Provider Directory

Locations

46 N Main St
West Brookfield, MA 01585
Phone (508) 867-8977

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DACACA

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1205032463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 NORTH MAIN STREET",
            "city": "WEST BROOKFIELD",
            "state": "MA",
            "postal_code": "015851044",
            "telephone_number": "508-867-8977",
            "fax_number": "508-867-7361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 NORTH MAIN ST",
            "city": "WEST BROOKFIELD",
            "state": "MA",
            "postal_code": "01585",
            "telephone_number": "508-867-8977",
            "fax_number": "508-867-7361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST BROOKFIELD FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "BROZ",
        "authorized_official_first_name": "GWEN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "508-867-8977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "73319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR JONES LICENSE",
            "identifier": "154490",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9787364",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR WILSON LICENSE",
            "identifier": "219183",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR BROZ LICENSE",
            "identifier": "73319",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Brookfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.