Elyse Renee Broucek

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

4045 E Bell Rd Ste 125
Phoenix, AZ 85032-2238

Phone

(602) 971-0268

NPI assigned

Oct 1, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alliance Dermatology and Mohs Center PCGroup PAC ID 7113144510, 10 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.11 of 100Reported as group

Quality

100

Improvement activities

40

Cost

83.7

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Alliance Dermatology & Mohs Center, PC

  • Specialist
  • Phoenix, AZ
  • NPI 1861813156
  Medicare reassignment Care Compare group
• Mark a Meyers

  • Specialist
  • Payson, AZ
  • NPI 1790246924
  NPD (past)

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1770180960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 E BELL RD STE 125",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322238",
            "telephone_number": "602-971-0268",
            "fax_number": "602-971-1556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 E BELL RD STE 125",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322238",
            "telephone_number": "602-971-0268"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13843 W Meeker Blvd",
            "address_purpose": "LOCATION",
            "city": "Sun City West",
            "state": "AZ",
            "postal_code": "853755285",
            "country_code": "US",
            "telephone_number": "623-584-1325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14506 W Granite Valley Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Sun City West",
            "state": "AZ",
            "postal_code": "853756013",
            "country_code": "US",
            "telephone_number": "623-584-1325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROUCEK",
        "first_name": "ELYSE",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-01",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Brosofske, OTR
• Ryan Scot Brossart
• Collyn Colby Brosseit
• Theda Brothers, FP
• Thomas Michael Brothers, LPC
• Heidi Brouelette, MA. LPC.
• Bernetta E Broughton, M.D.
• Alexis Broussard
• Thomas Brousseau, M.D.
• Lauri Janene Brouwer, ND

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.