Charles Anthony McBroom, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

019026519 Issued in IL

Practice address

1029 Howard St Ste 203
Evanston, IL 60202-3877

Phone

(847) 491-0660

NPI assigned

Mar 2, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257984000000",
    "number": "1285762971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 HOWARD ST STE 203",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602023877",
            "telephone_number": "847-491-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 HOWARD ST STE 203",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602023877",
            "telephone_number": "847-491-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCBROOM",
        "first_name": "CHARLES",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2009-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Laura Mayberry, PHD
• Lauren N. Mayer, APN-CRNA
• Lowery Ann Mayo, AUD.
• Yana Mazya, FNP
• Philip Eugene McAndrew, MD
• McCabe Speech and Language Services
• Sean Patrick McCabe, OT
• Stephanie Newell McCabe, MS, CCC-SLP
• Carol McCardell, MSW, LCSW
• Karah McCarl

• Dentist in Evanston, IL
• Providers in Evanston, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; 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.