Ametra Broome

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA20288 Issued in CA

Practice address

742 W Gardena Blvd
Gardena, CA 90247-5024

Phone

(310) 327-6044

NPI assigned

Jun 8, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in CA

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Exer Medical CorporationGroup PAC ID 9032359534, 336 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Exer Medical Corporation

  • Urgent Care Clinic/Center
  • Calabasas, CA
  • NPI 1588901532
  Medicare reassignment Care Compare group
• Anaheim Urgent Care, Inc.

  • Urgent Care Clinic/Center
  • Anaheim, CA
  • NPI 1962680033
  Medicare reassignment NPD
• Downtown Urgent Care

  • Urgent Care Clinic/Center
  • Los Angeles, CA
  • NPI 1740655208
  NPD
• Javier R. Rios MD a Professional Corporation

  • Family Medicine Physician
  • Riverside, CA
  • NPI 1841023801
  NPD (past)

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

{
    "created_epoch": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408060800000",
    "number": "1992931729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 W GARDENA BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902475024",
            "telephone_number": "310-327-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 W GARDENA BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902475024",
            "telephone_number": "310-327-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOME",
        "first_name": "AMETRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-08",
        "last_updated": "2014-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA20288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083640",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "ZZZ19972Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "ZZZ19972Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "ZZZ20075Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "ZZZ20075Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083641",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• La Mika M Broadnax-Evans
• Deodra Broadnax
• Hilarry Dian Broaster, PHARM.D
• Diamond Brock
• Rayme Michael Brock, R.N.
• Ronak Broukhim
• Charles Victor Brown Jr., M.D.
• Cristal Michell Brown
• Dawn Kamilah Brown, M.D.
• Diavian Kierra Brown

• Physician Assistant in Gardena, CA
• Providers in Gardena, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; 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.