Elyse Broderick, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-024714 Issued in IL

Practice address

430 Pennsylvania Ave Ste 240
Glen Ellyn, IL 60137-4464

Phone

(630) 967-2000

Fax

(630) 545-7816

NPI assigned

Aug 6, 2019

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dupage Medical Group LTDGroup PAC ID 5496667941, 1,326 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ebroderick250714@dulyhealthandcare.direct-ci.com

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.

• Dupage Medical Group LTD

  • Multi-Specialty Clinic/Center
  • Downers Grove, IL
  • NPI 1801833983
  Medicare reassignment Care Compare group
• Athletico LTD

  • Physical Therapist
  • Oak Brook, IL
  • NPI 1821085028
  Medicare reassignment NPD
• Athletico LTD

  • Clinic/Center
  • Lafayette, IN
  • NPI 1053044867

  Physical Therapist

  NPD

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

{
    "created_epoch": "1565049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1346895430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606740018",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 PENNSYLVANIA AVE STE 240",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374464",
            "telephone_number": "630-967-2000",
            "fax_number": "630-545-7816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "ELYSE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-06",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-024714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebroderick250714@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "430 Pennsylvania Ave Ste 240",
            "city": "Glen Ellyn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601374464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert Frank Brandys, DDS, MSD
• Margaret Mary Brant, OTR/L
• Michelle Brewer, DPT
• Brighter Vista Counseling
• Walter Briney, M.D.
• Brookdale Living Communities of Illinois-Ge, Inc.
• Ann Bruckelmeyer, LCSW, CADC
• Bettina Brydon, RT
• Betsy Buckley
• Skyler Budny

• Physical Therapist in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.