Alexis Broach

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

719 Little Hampton LN
Gotha, FL 34734-4713

Phone

(205) 789-5756

NPI assigned

Feb 22, 2023

Last updated

Feb 22, 2023By 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

Medicare fee-for-service enrollment

Enrolled in FL

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

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brave Health Inc.Group PAC ID 8123458981, 112 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brave Health Inc.

  • Community/Behavioral Health Agency
  • Miami, FL
  • NPI 1821588674
  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932
  Medicare reassignment

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

{
    "created_epoch": "1677024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1548968191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 LITTLE HAMPTON LN",
            "city": "GOTHA",
            "state": "FL",
            "postal_code": "347344713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 LITTLE HAMPTON LN",
            "city": "GOTHA",
            "state": "FL",
            "postal_code": "347344713",
            "telephone_number": "205-789-5756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROACH",
        "first_name": "ALEXIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-22",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A & S Quality Care
• Brandon Bass
• Tanya Sue Berisford, MSW
• Sydney Lauren Bialosuknia
• Julisa G Burns
• Renee Castile
• Carla C Chen, APRN
• Ebency Chevelon
• Raquel Cobbs

• Mental Health Counselor in Gotha, FL
• Providers in Gotha, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.