Vadjista Broumand, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

235818 Issued in NY

Practice address

4110 Medical Center Dr
Suite 110
Fayetteville, NY 13066

Phone

(315) 663-0100

Fax

(315) 663-0052

NPI assigned

Sep 6, 2005

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

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Dermatology

Education

University of Miami, LM Miller School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr. Fazeli and Dr. Broumand LLCGroup PAC ID 0446358063, 11 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Dr. Fazeli & Dr. Broumand LLC

  • Dermatology Physician
  • Fayetteville, NY
  • NPI 1336235639

  NY

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418169600000",
    "number": "1376537308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 MEDICAL CENTER DR",
            "address_2": "SUITE 110",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "13066",
            "telephone_number": "315-663-0100",
            "fax_number": "315-663-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 MEDICAL CENTER DR",
            "address_2": "SUITE 110",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "13066",
            "telephone_number": "315-663-0100",
            "fax_number": "315-663-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUMAND",
        "first_name": "VADJISTA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-06",
        "last_updated": "2014-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "235818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Hartman Brenizer, M.A., LMFT (LICENSED
• Erica L Brier-Kennedy, LMFT
• Mark Briggs, LCSW
• Jenaye Karin Broe, FNP-C
• Dana Rae Brompton, DDS
• Edith P Brown, LMHC
• Joseph Bulone
• Chanele M Burgun, MD
• Jessica A Burt, PT, DPT
• Cornelia Maria Buur, M.S.W.

• All providers in Fayetteville, NY
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; 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.
• 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.