Charlene Bell Broome, M.D.

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

12482 Issued in MS

Practice address

6414 U S Highway 98
Ste 80
Hattiesburg, MS 39402-7815

Phone

(601) 261-1800

Fax

(601) 261-1801

NPI assigned

Jul 18, 2006

Sex

Female

Sole proprietor

No

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.

• Hattiesburg Clinic PA

  • Multi-Specialty Clinic/Center
  • Hattiesburg, MS
  • NPI 1740213446

  MS

  Medicare reassignment NPD
• Delta Asthma & Allergy

  • Allergy & Immunology Physician
  • Greenville, MS
  • NPI 1841491404

  Allergy & Immunology

  NPD (past) Authorized official
• Hattiesburg Clinic, PA

  • Primary Care Clinic/Center
  • Flowood, MS
  • NPI 1912600354
  NPD
• Mississippi Asthma & Allergy Clinic PA

  • Allergy & Immunology Physician
  • Jackson, MS
  • NPI 1902882251

  Allergy & Immunology

  NPD (past)

Medicare fee-for-service enrollment

Enrolled in MS

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

Interoperability endpoints

• Direct secure messaging: cbroome54890@directpatientrecord.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 11, 2020.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1720007040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-261-1800",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6414 U S HIGHWAY 98",
            "address_2": "STE 80",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394027815",
            "telephone_number": "601-261-1800",
            "fax_number": "601-261-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOME",
        "first_name": "CHARLENE",
        "middle_name": "BELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "12482",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MS",
            "license": "12482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0119222",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cbroome54890@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "6414 U S Highway 98",
            "address_2": "Ste 80",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394027815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Beyonce Brock
• Marty Jacob Brock, DPT
• Honey Brooks, OTR
• Shalisha Brooks, PCMHT
• Tommy Brooks, HIS
• Stephanie Broome
• Gerald B Broussard Jr., MD
• Heath Jude Broussard II, DO
• Janice Brown-Jones
• Amanda Brown, LMSW

• All providers in Hattiesburg, MS
• Allergy & Immunology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; 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.