Individual provider Active NPI

Katherine Livesay Broering, M.D.

  • Pediatrics Physician
  • Mason, OH
National Provider Identifier
1609142579
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35.125398 Issued in OH
Practice address
6010 S Mason Montgomery Rd
Mason, OH 45040-3706
Phone
(513) 246-7000
Fax
(513) 204-6355
NPI assigned
Mar 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35.125398 OH Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

6010 S Mason Montgomery Rd
Mason, OH 45040-3706

Mailing address

4685 Forest Ave Ste C
Cincinnati, OH 45212-3359
Phone (513) 246-7000

Other identifiers 1

IdentifierTypeStateIssuer
35.125398OtherOHOHIO LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20150616001575 OH Practitioner - Pediatric Medicine 4284945387 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.125398OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trihealth G, LLC CurrentSince Jul 27, 2015 Accepting new patients
Trihealth G LLC Pediatrics CurrentSince Jul 27, 2015 Accepting new patients
Trihealth G LLC Pediatrics Past Accepting new patients

Locations

2001 Anderson Ferry Rd
Cincinnati, OH 45238
Phone (513) 922-1200

6010 S Mason Montgomery Rd
Mason, OH 45040
Phone (513) 246-2300

4685 Forest Ave
Ste C
Norwood, OH 45212
Phone (513) 246-7796

Interoperability endpoints

  • Direct secure messaging: kbroering152439@direct.trihealth.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433980800000",
    "number": "1609142579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4685 FOREST AVE STE C",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452123359",
            "telephone_number": "513-246-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6010 S MASON MONTGOMERY RD",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450403706",
            "telephone_number": "513-246-7000",
            "fax_number": "513-204-6355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROERING",
        "first_name": "KATHERINE",
        "middle_name": "LIVESAY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-26",
        "last_updated": "2015-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.125398",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO LICENSE",
            "identifier": "35.125398",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mason, OH

Sources for this page

Verify at the official NPI Registry.