Individual provider Active NPI

Shannon Marie Brostad, PT

  • Physical Therapist
  • Des Moines, IA
National Provider Identifier
1477608917
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
03523 Issued in IA
Practice address
1801 Hickman Rd
Des Moines, IA 50314-1548
Phone
(515) 282-5621
NPI assigned
Jan 24, 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
Physical Therapist 225100000X 03523 IA Primary

Addresses

Primary practice location

1801 Hickman Rd
Des Moines, IA 50314-1548

Mailing address

4015 Fagen Dr
Des Moines, IA 50310-4047
Phone (515) 276-6676

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240723002133 IA Practitioner - Physical Therapist in Private Practice 0648716936 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
03523IAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Broadlawns Medical Center CurrentSince Jun 3, 2024 Accepting new patients
Broadlawns Medical Center CurrentSince Jun 3, 2024 Accepting new patients

Locations

1801 Hickman Rd
Des Moines, IA 50314
Phone (515) 282-2200

2508 E University Ave
Des Moines, IA 50317
Phone (515) 282-2362

580 SW 9th St
Ste 100
Des Moines, IA 50309
Phone (515) 282-2362

2970 University Ave
Des Moines, IA 50311
Phone (515) 216-5100

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477608917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 FAGEN DR",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503104047",
            "telephone_number": "515-276-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 HICKMAN RD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503141548",
            "telephone_number": "515-282-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROSTAD",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "03523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.