Jaytavia Broadnax

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

2311 Alt 19
Palm Harbor, FL 34683-2631

Phone

(630) 200-4823

NPI assigned

Dec 9, 2020

Last updated

Dec 9, 2020By 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 identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Brave Health Inc.Group PAC ID 8123458981, 112 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Brave Health Inc.

  • Community/Behavioral Health Agency
  • Miami, FL
  • NPI 1821588674
  Medicare reassignment Care Compare group NPD
• Carlton Manor, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • St Petersburg, FL
  • NPI 1306862511
  NPD (past)
• Carlton Manor, Inc.

  • Case Management Agency
  • St Petersburg, FL
  • NPI 1285078758
  NPD (past)

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1255937884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10044 PALERMO CIR APT 203",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336195073",
            "telephone_number": "630-200-4823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 ALT 19",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346832631",
            "telephone_number": "630-200-4823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADNAX",
        "first_name": "JAYTAVIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-09",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306862511",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jbroadnax@carltonmanor.org",
            "affiliation": "Y",
            "endpointDescription": "Work email",
            "affiliationName": "CARLTON MANOR, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "45 Westwood Ter N",
            "city": "St Petersburg",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337108325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brain and Spine Neuroscience Institute, LLC
• Brain and Spine Neuroscience Institute, LLC
• Janise A Brewington, FNP
• Karen Brits, OCCUPATIONAL THERAPI
• Elizabeth Lynn Britt
• Christina Broady
• Jessica Marie Brooks, PA-C
• Scott Lee Brotherton, MD
• Alan Wayne Brown
• Kimberly Grayson Brown, RPH

• Mental Health Counselor in Palm Harbor, FL
• Providers in Palm Harbor, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; 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.
• 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.