Philip George Broeckel Jr., MD

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

G37332 Issued in CA

Practice address

9888 Genesee Ave
La Jolla, CA 92037-1205

Phone

(858) 626-6151

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pbroeckel18864@scrippshlth.medalliesdirect.net

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.

• La Jolla Observation Medicine

  • Emergency Medicine Physician
  • La Jolla, CA
  • NPI 1780122986
  NPD
• Scripps Health

  dba Scripps Hospital Medical Services

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1487928891
  NPD
• Edwin Iliff, M.D.,Inc.

  dba La Jolla Emergency Physician's Medical Group

  • Emergency Medicine Physician
  • La Jolla, CA
  • NPI 1588694855
  NPD (past)

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287446400000",
    "number": "1629146600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3198 AVENIDA HACIENDA",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920297925",
            "telephone_number": "760-715-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371205",
            "telephone_number": "858-626-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROECKEL",
        "first_name": "PHILIP",
        "middle_name": "GEORGE",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2010-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "CA",
            "license": "G37332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "G37332",
            "identifier": "MEDICAL LICENSE",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles W Briscoe, DDS
• Brittany J. Noris DDS, Inc
• David E Brockett, DDS
• Jeffrey Eastman Brockett, DDS
• Megan Broderick, MFT
• David H Broide, MB CHB
• Robert E Brookover, MD
• Amy Michele Brooks, CMT
• Helen Elizabeth Broome, M.D.
• Brook L Brouha, MD/PHD

• Emergency Medical Services (Emergency Medicine) Physician in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Emergency Medical Services (Emergency Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; 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.