Denise Michelle McBroom, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9111719 Issued in FL

Practice address

390 Challenger Rd
Cape Canaveral, FL 32920-4200

Phone

(321) 633-8640

NPI assigned

Jan 2, 2008

Last updated

Jan 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: denise.mcbroom.1@17832.direct.athenahealth.com
• FHIR API: https://fhir4.healow.com/fhir/r4/EGDCBD

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.

• North Brevard Medical Support, Inc

  dba Parrish Medical Group

  • Multi-Specialty Clinic/Center
  • Titusville, FL
  • NPI 1609834886
  NPD (past)
• Saint Josephs Medical Group Inc

  • Family Medicine Physician
  • Pembroke, GA
  • NPI 1154349850
  NPD (past)
• SJC Medical Group Inc

  • Family Medicine Physician
  • Savannah, GA
  • NPI 1811233828
  NPD (past)

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1558546267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 E. 72ND STREET",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314054913",
            "telephone_number": "912-819-7878",
            "fax_number": "912-819-5044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 CHALLENGER RD",
            "city": "CAPE CANAVERAL",
            "state": "FL",
            "postal_code": "329204200",
            "telephone_number": "321-633-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCBROOM",
        "first_name": "DENISE",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-02",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9111719",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "003185",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "972007681A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gairy Leblanc
• Amanda Reneau Lovell, LPN
• Melissa Ann Lyon
• Casandra Marino
• Jennifer Marquez
• MD Moulton LLC (Mike's Pharmacy)
• Joseph John Mignogna, MD
• Amy Miller, CNA
• Moa Miami LLC
• Johnny Joseph Morales, LAT, ATC

• Physician Assistant in Cape Canaveral, FL
• Providers in Cape Canaveral, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.