Active NPI
Bernetta E Broughton, M.D.
- Pediatric Adolescent Medicine Physician
- Phoenix, AZ
National Provider Identifier
1235134859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 15087
- Practice address
- 4700 N 51St Ave
Ste 4
Phoenix, AZ 85031-1237 - Phone
- (623) 846-7575
- Fax
- (623) 247-6386
- NPI assigned
- Jun 20, 2005
- Last updated
- Sep 11, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 15087 | AZ | |
| Pediatric Adolescent Medicine Physician | 2080A0000X | 15087 | AZ | Primary |
Addresses
Primary practice location
4700 N 51St Ave
Ste 4
Phoenix, AZ 85031-1237
Mailing address
4700 N 51St Ave
Ste 4
Phoenix, AZ 85031-1237
Phone (623) 846-7575
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 251794 | Medicaid | AZ | |
| AZ0182590 | Other | AZ | BCBS |
| 85031A006 | Other | AZ | TRICARE |
| 1Z8746 | Other | AZ | HEALTHNET |
| 770934 | Other | AZ | UNITED HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15087 | AZ | MD | Pediatric Adolescent Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Scottsdale Pediatric Associates | Pediatrics | Past | Accepting new patients |
| Maryvale Pediatric Clinic | Pediatrics | Past | Accepting new patients |
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.
-
- Pediatrics Physician
- Scottsdale, AZ
- NPI 1275797235
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1235134859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 N 51ST AVE",
"address_2": "STE 4",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850311237",
"telephone_number": "623-846-7575",
"fax_number": "623-247-6386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 N 51ST AVE",
"address_2": "STE 4",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850311237",
"telephone_number": "623-846-7575",
"fax_number": "623-247-6386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUGHTON",
"first_name": "BERNETTA",
"middle_name": "E",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-06-20",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "15087",
"primary": false
},
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "AZ",
"license": "15087",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "251794",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "AZ0182590",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "85031A006",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "1Z8746",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "770934",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.