Alisa Ann Bromberg, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G81092 Issued in CA

Practice address

881 Alma Real Dr Ste 316
Pacific Palisades, CA 90272-5061

Phone

(310) 454-2296

Fax

(310) 454-2295

NPI assigned

Feb 12, 2007

Last updated

Jan 9, 2024By the provider in NPPES

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 CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Providence Saint Johns Medical Foundation

  dba Saint John's Physician Partners

  • Specialist
  • Santa Monica, CA
  • NPI 1770093734

  Pediatrics

  Medicare reassignment NPD
• Dignity Health

  dba St. John's Regional Medical Center

  • General Acute Care Hospital
  • Oxnard, CA
  • NPI 1073665360
  NPD (past)
• Providence Saint John's Health Center

  • General Acute Care Hospital
  • Santa Monica, CA
  • NPI 1124026273
  NPD (past)

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1447392113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 MONUMENT ST STE 220",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723898",
            "telephone_number": "310-454-2296",
            "fax_number": "310-454-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "881 ALMA REAL DR STE 316",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902725061",
            "telephone_number": "310-454-2296",
            "fax_number": "310-454-2295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "970 Monument St Ste 220",
            "address_purpose": "LOCATION",
            "city": "Pacific Palisades",
            "state": "CA",
            "postal_code": "902723898",
            "country_code": "US",
            "telephone_number": "310-454-2296",
            "fax_number": "310-454-2295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROMBERG",
        "first_name": "ALISA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G81092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "abromberg473244@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "881 Alma Real Dr Ste 101",
            "city": "Pacific Palisades",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902723792",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alan S Bookin, MD
• Diane Marie Boureston Grossman, LMFT
• Sabine Braunsberg
• Bridges to Recovery, Inc.
• Gayle Sandra Brodzki, PH.D.
• Bruce Beddoe DC a Chiropractic Corporation (Palisades Holistic Chiropractic)
• Marian Buzga, LCSW
• C Philip Amoils MD Inc
• Julie Marie Calvin, CCC-SLP
• Lisa Dora Canty, MSW

• Pediatrics Physician in Pacific Palisades, CA
• Providers in Pacific Palisades, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.