Active NPI
Kristin Royce Brodie, MD
- Otolaryngology Physician
- Bridgewater Corners, VT
National Provider Identifier
1356563258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 1782421
- Practice address
- 123 Fancher Rd
Bridgewater Corners, VT 05035-9736 - Phone
- (315) 436-8864
- NPI assigned
- May 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 178242-01 | NY | |
| Otolaryngology Physician | 207Y00000X | 1782421 | NY | Primary |
Addresses
Primary practice location
123 Fancher Rd
Bridgewater Corners, VT 05035-9736
Mailing address
PO Box 382
Bridgewater Corners, VT 05035-0382
Phone (315) 436-8864
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01132609 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178242-01 | NY | MD | Otolaryngology Physician |
| 1782421 | NY | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701993600000",
"number": "1356563258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 382",
"city": "BRIDGEWATER CORNERS",
"state": "VT",
"postal_code": "050350382",
"telephone_number": "315-436-8864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 FANCHER RD",
"city": "BRIDGEWATER CORNERS",
"state": "VT",
"postal_code": "050359736",
"telephone_number": "315-436-8864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODIE",
"first_name": "KRISTIN",
"middle_name": "ROYCE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2023-12-08",
"certification_date": "2023-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": "NY",
"license": "178242-01",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "NY",
"license": "1782421",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01132609",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgewater Corners, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.