Individual provider Active NPI

Candace Marie Broussard-Steinberg, MD

  • Dermatology Physician
  • Quincy, MA
National Provider Identifier
1568810935
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
1017761 Issued in MA
Practice address
1250 Hancock St Ste 505S
Quincy, MA 02169-4339
Phone
(781) 253-7165
Fax
(781) 253-7166
NPI assigned
May 26, 2016
Last updated
Mar 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 1017761 MA Primary
Dermatology Physician 207N00000X 01084188A IN

Addresses

Primary practice location

1250 Hancock St Ste 505S
Quincy, MA 02169-4339

Mailing address

1250 Hancock St Ste 505S
Quincy, MA 02169-4339
Phone (781) 253-7165

Other identifiers 1

IdentifierTypeStateIssuer
201369530MedicaidIN

Other names 1

  • Candace Marie Broussard Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, MA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200807000205 IN Practitioner - Dermatology 3577854280 Reassigns benefits to 1 organization
I20240308002190 MA Practitioner - Dermatology 3577854280 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of South Carolina School of Medicine, 2016
Medicare assignment
May accept Medicare assignment
Group practices
Dermcare Experts LLCGroup PAC ID 8224257910, 3 clinicians

Practice addresses (Care Compare)

1250 Hancock St
505S
Quincy, MA 02169-4339
Phone (781) 253-7165

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions384
Removal of nail tissue1-10
Removal or shaving of skin growth40
Skin biopsy99

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Dermcare Experts LLC Dermatology CurrentSince Feb 24, 2024 Accepting new patients
Dermatology Center of Southern Indiana, P.C. CurrentSince Jul 20, 2020 Accepting new patients
Dermcare Experts LLC Dermatology CurrentSince Mar 17, 2024 Accepting new patients

Locations

1200 S Rogers St
Bloomington, IN 47403
Phone (812) 339-6434

1250 Hancock St
#505S
Quincy, MA 02169
Phone (781) 253-7165

1250 Hancock St
Ste 505S
Quincy, MA 02169
Phone (781) 253-7165

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ez_00094

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1464220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1568810935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 HANCOCK ST STE 505S",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021694339",
            "telephone_number": "781-253-7165",
            "fax_number": "781-253-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 HANCOCK ST STE 505S",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021694339",
            "telephone_number": "781-253-7165",
            "fax_number": "781-253-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD-STEINBERG",
        "first_name": "CANDACE",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-26",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "1017761",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01084188A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201369530",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDACE",
            "last_name": "BROUSSARD",
            "middle_name": "MARIE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Quincy, MA

Sources for this page

Verify at the official NPI Registry.