NPIMap

Organization Active NPI

Robert J. Brocker M.D., Inc.

  • Specialist
  • Youngstown, OH
National Provider Identifier
1376730838
Registry record updated Feb 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
35-053079 Issued in OH
Legal business name
ROBERT J. BROCKER M.D., INC.
Practice address
1616 Covington St
Youngstown, OH 44510-1244
Phone
(330) 747-9215
Fax
(330) 747-9248
NPI assigned
Sep 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2013

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

Authorized official

Name
Mrs. Linda J Eisenbraun
Title
Office Manager
Phone
(330) 747-9215

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 35-053079 OH Primary

Addresses

Primary practice location

1616 Covington St
Youngstown, OH 44510-1244

Mailing address

1616 Covington St
Youngstown, OH 44510-1244
Phone (330) 747-9215

Other identifiers 10

IdentifierTypeStateIssuer
000000150690OtherOHUNISON
285520211008OtherOHMEDICAL MUTUAL-YNGS OFF
0640453MedicaidOH
285520211-00OtherOHBWC
9340971OtherOHMEDICARE-YNGS
000000323539OtherOHANTHEM
1538350OtherOHGATEWAY
4127012OtherOHAETNA
285520211009OtherOHMEDICAL MUTUAL-WARREN OFF
9340972OtherOHMEDICARE-WARREN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361491200000",
    "number": "1376730838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 COVINGTON ST",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445101244",
            "telephone_number": "330-747-9215",
            "fax_number": "330-747-9248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 COVINGTON ST",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445101244",
            "telephone_number": "330-747-9215",
            "fax_number": "330-747-9248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT J. BROCKER M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2013-02-22",
        "status": "A",
        "authorized_official_last_name": "EISENBRAUN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "330-747-9215",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OH",
            "license": "35-053079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000150690",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL-YNGS OFF",
            "identifier": "285520211008",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0640453",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BWC",
            "identifier": "285520211-00",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-YNGS",
            "identifier": "9340971",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000323539",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1538350",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4127012",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL-WARREN OFF",
            "identifier": "285520211009",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-WARREN",
            "identifier": "9340972",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.