NPIMap

Individual provider Active NPI

Wynford Valentine Brome, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Worcester, MA
National Provider Identifier
1245378462
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA955 Issued in MA
Practice address
55 Lake Ave N
Worcester, MA 01655-0002
Phone
(508) 334-5220
Fax
(774) 441-6790
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 955 MA
Physician Assistant 363A00000X PA955 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-5348

Other practice location 1

88 East Newton Street
H-2, BMC Arrhythmia Center
Boston, MA 02118
Phone (617) 638-8776

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20080721000089 MA Practitioner - Physician Assistant 2163595463 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
955MAMDMarriage & Family Therapist
PA955MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Eldercare Physician Services LLC CurrentSince Jun 1, 2017 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Apr 8, 2022 Accepting new patients
Genesis Eldercare Physician Services LLC CurrentSince Jun 1, 2017 Accepting new patients
Ipc Hospitalists of New England PC Physician Assistant CurrentSince Mar 14, 2017 Accepting new patients
Umass Memorial Medical Group Inc Physician Assistant Past Accepting new patients

Locations

89 Morton St
Andover, MA 01810
Phone (978) 475-0944

2100 Dorchester Ave
Dorchestr Ctr, MA 02124
Phone (617) 506-2222

91 Water St
Milford, MA 01757
Phone (508) 458-4250

10 Veterans Memorial Dr
Milford, MA 01757
Phone (508) 473-6414

67 Union St
Natick, MA 01760
Phone (508) 383-1104

111 Huntoon Memorial Hwy
Rochdale, MA 01542
Phone (508) 892-4858

37 State Highway 6A
Sandwich, MA 02563
Phone (508) 888-8222

150 York St
Stoughton, MA 02072
Phone (781) 297-1101

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

123 Summer St
#273
Worcester, MA 01608
Phone (508) 363-6327

Interoperability endpoints

  • Direct secure messaging: wbrome205888@umassmemorial.direct-ci.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1245378462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-334-5220",
            "fax_number": "774-441-6790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "88 East Newton Street",
            "address_2": "H-2, BMC Arrhythmia Center",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02118",
            "country_code": "US",
            "telephone_number": "617-638-8776",
            "fax_number": "617-414-8772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROME",
        "first_name": "WYNFORD",
        "middle_name": "VALENTINE",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "955",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.