Staci Broadwell, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

4519 Issued in AZ

Practice address

3830 E Van Buren St
Phoenix, AZ 85008-6920

Phone

(602) 243-7277

Fax

(602) 286-0808

NPI assigned

Apr 21, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Staci Davis Former name

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Clinical Psychologist

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Banner Physician Specialists Arizona LLCGroup PAC ID 6204002272, 371 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.12 of 100Reported as group

Quality

76.35

Promoting interoperability

99

Improvement activities

40

Cost

71.55

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Banner Physician Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1821368218
  Medicare reassignment Care Compare group NPD
• Banner Physician Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Page, AZ
  • NPI 1366799355
  NPD
• Mountain Park Health Center - Dental

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1710146188
  NPD (past)

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

{
    "created_epoch": "1240272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1467696419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 N 3RD ST STE 4020",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850044608",
            "telephone_number": "602-323-3492",
            "fax_number": "602-323-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 E VAN BUREN ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850086920",
            "telephone_number": "602-243-7277",
            "fax_number": "602-286-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWELL",
        "first_name": "STACI",
        "name_prefix": "Prof.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-21",
        "last_updated": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "017898",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "4519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206766",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "DAVIS",
            "credential": "PSY.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bro Investments, LLC
• Dennis E. Broadbent, PH.D.
• Svetlana Broadstock, LDO
• Broadway Family Pharmacy PLLC
• Broadway Monitoring LLC
• Nancy C Broc, NNP
• Emily Brocato, MS, RDN
• Marian Brock Andersen, DNP, FNP-BC
• Brock Surgical Group, LLC
• Andrea Kay Brock, ANP

• Clinical Psychologist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.
• 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.