Individual provider Active NPI

Jessica M. Broz, PC

  • Professional Counselor
  • Toledo, OH
National Provider Identifier
1366648321
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
C 0007845 Issued in OH
Practice address
123 22ND St
Toledo, OH 43624-1107
Phone
(419) 241-6191
Fax
(419) 255-5623
NPI assigned
Jun 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X C 0007845 OH Primary

Addresses

Primary practice location

123 22ND St
Toledo, OH 43624-1107

Mailing address

123 22ND St
Toledo, OH 43624-1107
Phone (419) 241-6191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20241017002895 OH Practitioner - Mental Health Counselor 9931631710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
University of Toledo College of Medicine, 2003
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1425 Starr Ave
Toledo, OH 43605-2456

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C 0007845OHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Unison Behavioral Health Group, Inc. CurrentSince Aug 12, 2024 Accepting new patients
Unison Behavioral Health Group, Inc Past Accepting new patients

Locations

1425 Starr Ave
Toledo, OH 43605
Phone (419) 259-4506

544 E Woodruff Ave
Toledo, OH 43604
Phone (419) 214-4673

Interoperability endpoints

  • Direct secure messaging: jbroz247464@direct.promedica.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366648321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 22ND ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436241107",
            "telephone_number": "419-241-6191",
            "fax_number": "419-255-5623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 22ND ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436241107",
            "telephone_number": "419-241-6191",
            "fax_number": "419-255-5623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROZ",
        "first_name": "JESSICA",
        "middle_name": "M.",
        "credential": "PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C 0007845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.