Eric Scott Brockman, DMD, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DS028499L Issued in PA

Practice address

7601 Castor Ave Ste 300
Philadelphia, PA 19152-4027

Phone

(215) 722-4290

Fax

(215) 722-3734

NPI assigned

Nov 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 26, 2017 through Apr 26, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Tom Fuji, DDS

  • Periodontics
  • Philadelphia, PA
  • NPI 1396808556
  NPD (past)
• Periodontal & Implant Associates of Middle Tennessee, PLLC

  • Periodontics
  • Nashville, TN
  • NPI 1174952642
  NPD (past)

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1336211614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 MEADOWBROOK DR APT 635",
            "city": "HUNTINGDON VALLEY",
            "state": "PA",
            "postal_code": "190066913",
            "telephone_number": "206-498-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 CASTOR AVE STE 300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191524027",
            "telephone_number": "215-722-4290",
            "fax_number": "215-722-3734"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1685 Crown Ave",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176016322",
            "country_code": "US",
            "telephone_number": "717-482-6542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "ERIC",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DMD, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "00007825",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WI",
            "license": "1001067-15",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TN",
            "license": "11876",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS028499L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlene M Brock, MD
• David G. Brock, M.D.
• Arshay Brockington
• Michelle Brockington
• Taniqua Brockington
• Michael S. Broder, PH.D.
• Kaitlyn Broderick, MD
• Garrett M Brodeur, MD
• Nicola Brodie, MD
• Edward S Brodkin, MD

• Periodontics in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Periodontics in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.