Brad Broyles, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME 0071307 Issued in FL

Practice address

2018 Talley Rd
Leesburg, FL 34748-3426

Phone

(352) 315-7500

Fax

(352) 360-6582

NPI assigned

Apr 17, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

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

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifestream Behavioral Center Inc

  • Psychiatric Hospital
  • Leesburg, FL
  • NPI 1902802002

  Psychiatry

  Medicare reassignment NPD
• Mental Health Resource Center Inc

  • Community Health Clinic/Center
  • Jacksonville, FL
  • NPI 1851407365
  Medicare reassignment NPD
• Lifestream Behavioral Center Inc

  • Primary Care Clinic/Center
  • Leesburg, FL
  • NPI 1659613776
  NPD
• Mental Health Center of Jacksonville, Inc.

  • Community Health Clinic/Center
  • Jacksonville, FL
  • NPI 1366558132
  NPD (past)

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1629033493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 491000",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347491000",
            "telephone_number": "352-315-7500",
            "fax_number": "352-360-6582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2018 TALLEY RD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483426",
            "telephone_number": "352-315-7500",
            "fax_number": "352-360-6582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROYLES",
        "first_name": "BRAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME 0071307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "263317500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD #",
            "identifier": "03386",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janis Brooks, CRNA
• Christina Brown
• Gregory Mark Brown, M.D.
• Stephanie Brown
• Vickie Brown
• Tatsiana Bryko Giles
• Buchanan Physical Medicine, Inc (Buchanan Health Center)
• Tige R Buchanan, D.C.
• Reese Buckhalter, PT, DPT
• Nancy Bullock, LCSW

• Psychiatry Physician in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.