Katilyn C Broberg, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2168 Issued in KS

Practice address

2635 W Douglas Ave
Wichita, KS 67213-2605

Phone

(316) 942-7496

NPI assigned

Aug 1, 2022

Last updated

Aug 1, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Mid West Medical College, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wichita Optometry, P.a.Group PAC ID 2567541451, 11 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

90.45 of 100Reported as group

Quality

80.9

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kati.broberg@direct.revolutionehr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wichita Optometry, P.a.

  • Optometrist
  • Wichita, KS
  • NPI 1083676936
  Medicare reassignment Care Compare group NPD
• Wichita Optometry P.a.

  • Optometrist
  • Wichita, KS
  • NPI 1821668799
  NPD

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1801522875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1652 S BUTTERNUT ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672307633",
            "telephone_number": "316-305-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 W DOUGLAS AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672132605",
            "telephone_number": "316-942-7496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROBERG",
        "first_name": "KATILYN",
        "middle_name": "C",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-08-01",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "2168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48-1046124",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kati.broberg@direct.revolutionehr.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2635 W Douglas Ave",
            "city": "Wichita",
            "state": "KS",
            "country_code": "US",
            "postal_code": "672132605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Paige Broadhurst
• Broadmoor One LLC
• Broadway Home Medical Inc
• Broadway Home Medical, Inc
• Broadway Pharmacy PA
• Brock L. McKay LLC
• Lindsay C Brock, LMFT
• Tanner D Brock, DDS
• Taylor Nicole Brock, DDS
• Jenna Brockel

• Optometrist in Wichita, KS
• Providers in Wichita, KS by specialty
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; 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.