Jessica Lynn Broodryk, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2020014783 Issued in MO

Practice address

200 Minor Hall
Berkeley, CA 94720-0001

Phone

(510) 642-2020

NPI assigned

Jun 16, 2020

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

Other names 1

• Jessica Lynn Blomenkamp Former name

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Louis Society for the BlindGroup PAC ID 9739478439, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.88 of 100Reported as group

Quality

83.76

Improvement activities

40

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 and National Provider Directory roles.

• St Louis Society for the Blind

  • Low Vision Rehabilitation Optometrist
  • Saint Louis, MO
  • NPI 1942661186
  Medicare reassignment Care Compare group NPD
• Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1902816077
  Medicare reassignment NPD
• Curators of the University of Missouri

  • Optometrist
  • Saint Louis, MO
  • NPI 1679664718
  Medicare reassignment NPD
• Curators of the University of Missouri

  • Optometrist
  • Saint Louis, MO
  • NPI 1922190198
  Medicare reassignment NPD
• Envision Eye Specialists PC

  • Ophthalmology Physician
  • Fenton, MO
  • NPI 1205072360
  Medicare reassignment NPD
• Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1740067719
  NPD
• Curators of the University of Missouri

  • Community/Retail Pharmacy
  • Jefferson City, MO
  • NPI 1740083641
  NPD
• St. Louis Society for the Blind

  • Voluntary or Charitable Agency
  • Saint Louis, MO
  • NPI 1710358957
  NPD (past)

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1588289474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MINOR HALL",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947200001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MINOR HALL",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947200001",
            "telephone_number": "510-642-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROODRYK",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-16",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2020014783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BLOMENKAMP",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Phoebe Brock-Dolas
• Kimberly L Brodsky, PHD
• Bennett Roy Brodwin, DMD
• Monika Silvia Broecker, MS, MA
• Jessica Broitman, PHD
• Kyla Brooke, LMFT, CMT
• Kylie Brookes, M.D.
• Nakiesha Brooks-Davis, MS, ATC
• Faith Serenity Shavis Brooks-Hunter, M.A., CCC-SLP
• Charlotte Brooks, LVN

• Optometrist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; 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.