Dale Broome, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004286 Issued in GA

Practice address

901 18TH St E
Tifton, GA 31794-3648

Phone

(229) 353-7720

NPI assigned

Nov 9, 2006

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 identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Merit-based Incentive Payment System (MIPS)

Final score

81.02 of 100Reported as group

Quality

57.87

Promoting interoperability

100

Improvement activities

40

Cost

75.97

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Tift Regional Health System Inc

  • Vascular Surgery Physician
  • Tifton, GA
  • NPI 1184080079
  NPD
• Tift Regional Health System Inc

  • Ophthalmology Physician
  • Tifton, GA
  • NPI 1790280857
  NPD
• Tift Regional Health System, Inc.

  • Rural Health Clinic/Center
  • Adel, GA
  • NPI 1871816918
  NPD

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1598835969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1623 MADISON AVE",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943757",
            "telephone_number": "229-353-7720",
            "fax_number": "229-353-7791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-353-7720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1623 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Tifton",
            "state": "GA",
            "postal_code": "317943757",
            "country_code": "US",
            "telephone_number": "229-353-7720",
            "fax_number": "229-353-7791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROOME",
        "first_name": "DALE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "004286",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "584584358A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dale.broome@trhs.cernerdirect.com",
            "affiliation": "N",
            "address_1": "901 18th St E",
            "city": "Tifton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317943648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Denise Broadwater, CRNA
• Belinda Kay Brock, LPC009749
• Margaret Anne Brock
• Courtney Brooke, NP
• Lee Michelle Brooks, LCSW
• Clinton Jeffery Brown, AA
• Donovan Kaine Brown, M.D.
• Karen Elizabeth Brown, PAC
• Rebecca Angeles Denise Brown, NP-C
• Stacy Brown, OT

• All providers in Tifton, GA
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; 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.