Active NPI
Iris A. Brossard, M.D.
- Neurology Physician
- St Cloud, MN
National Provider Identifier
1780656702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 51670
- Practice address
- 1200 Sixth Ave No
Centra Care Clinic
St Cloud, MN 56303-2735 - Phone
- (320) 252-5731
- NPI assigned
- Feb 3, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MD043369E | PA | |
| Neurology Physician | 2084N0400X | 51670 | MN | Primary |
Addresses
Primary practice location
1200 Sixth Ave No
Centra Care Clinic
St Cloud, MN 56303-2735
Mailing address
1200 Sixth Ave No
Centra Care Clinic
St Cloud, MN 56303-2735
Phone (320) 252-5731
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001168197 | Medicaid | PA |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD043369E | PA | MD | Specialist |
| 51670 | MN | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centracare Clinic | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Multi-Specialty Clinic/Center
- St Joseph, MN
- NPI 1134121759
-
- Multi-Specialty Clinic/Center
- Saint Cloud, MN
- NPI 1225030844
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245196800000",
"number": "1780656702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 SIXTH AVE NO",
"address_2": "CENTRA CARE CLINIC",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "563032735",
"telephone_number": "320-252-5731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 SIXTH AVE NO",
"address_2": "CENTRA CARE CLINIC",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "563032735",
"telephone_number": "320-252-5731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROSSARD",
"first_name": "IRIS",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-03",
"last_updated": "2009-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "PA",
"license": "MD043369E",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MN",
"license": "51670",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001168197",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.