Active NPI
Jo-Ellen R Brodeur, FAMILY PRACTICE
- Physician Assistant
- Worcester, MA
National Provider Identifier
1649281106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1962
- Practice address
- 26 Queen St
Medical
Worcester, MA 01610-2473 - Phone
- (508) 860-7700
- Fax
- (508) 860-7990
- NPI assigned
- Aug 10, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1962 | MA | Primary |
Addresses
Primary practice location
26 Queen St
Medical
Worcester, MA 01610-2473
Mailing address
26 Queen St
Medical
Worcester, MA 01610-2473
Phone (508) 860-7700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 93605 | Other | MA | FALLON SELECT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1962 | MA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1649281106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 QUEEN ST",
"address_2": "MEDICAL",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016102473",
"telephone_number": "508-860-7700",
"fax_number": "508-860-7990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 QUEEN ST",
"address_2": "MEDICAL",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016102473",
"telephone_number": "508-860-7700",
"fax_number": "508-860-7990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODEUR",
"first_name": "JO-ELLEN",
"middle_name": "R",
"credential": "FAMILY PRACTICE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-10",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "1962",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON SELECT",
"identifier": "93605",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.