Robert Wright Brodie, PA C
Individual provider Active NPI Physician Assistant · Perryville, MO
NPI 1801889183 · NPPES record last updated Mar 29, 2012
Key facts
- NPI
- 1801889183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2001023599 (MO)
- Practice address
- 206 Hospital LN
Suite 202
Perryville, MO 63775-1276 - Phone
- (573) 768-3396
- Fax
- (573) 768-3397
- NPI assigned
- Aug 23, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Hospital Perry
Practice addresses (Care Compare)
434 N W St
Perryville, MO 63775-1359
Phone (573) 547-2536
Hospital & facility affiliations
- Mercy Hospital Perry
- Mercy Hospital Southeast
- Saint Francis Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100218000215 | MO | Practitioner - Physician Assistant | 7810031572 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2001023599 | MO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Hospital Perry | Current |
Accepting new patients | |
| Mercy Hospital Perry | Current |
Accepting new patients | |
| Mercy Hospital Perry | Past | Accepting new patients |
Locations
434 N West St
Perryville, MO 63775
Phone (573) 547-2530
206 Hospital Ln
Ste 201
Perryville, MO 63775
Phone (573) 547-4899
206 Hospital Ln
Ste 202
Perryville, MO 63775
Phone (573) 547-4899
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2001023599 | MO | Yes |
Addresses
Primary practice location
206 Hospital LN
Suite 202
Perryville, MO 63775-1276
Mailing address
206 Hospital LN
Suite 202
Perryville, MO 63775-1276
Phone (573) 768-3396
Other providers in Perryville, MO
- Beyond Valor Counseling and Consulting, LLC
- Body Works Chiropractic Studio, LLC
- Katherine Boxdorfer
- Cynthia M Bradley
- Ann Marie Brewster
- Brost & Strohmeyer Family Eye Care PC
- Dalton Brown
- Gavin James Brown
- Nicole Dawn Brown
- Buchheit Chiropractic, P.C.
All providers in Perryville, MO · Physician Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.