Kim Broadnax, LISW is a medicare enrolled "Social Worker - Clinical" provider in Brooklyn Hts, Ohio. Her current practice location is
925 Keynote Cir Ste 300, Brooklyn Hts, Ohio. You can reach out to her office (for appointments etc.) via phone at
(216) 931-1400.
Kim Broadnax is licensed to practice in Ohio (license number I.0005832) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1417411018.
Healthcare Provider's Profile
| Full Name | Kim Broadnax |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 925 Keynote Cir Ste 300, Brooklyn Hts, Ohio |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1417411018
- Provider Enumeration Date: 01/28/2019
- Last Update Date: 01/28/2019
Medicare PECOS Information:
- PECOS PAC ID: 4688037021
- Enrollment ID: I20230831003642
Medical Identifiers
Medical identifiers for Kim Broadnax such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1417411018 | NPI | - | NPPES |
| 1972553063 | Other | OH | NPI |
| 9072202 | Medicaid | OH | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1041C0700X | Social Worker - Clinical | I.0005832 (Ohio) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kim Broadnax allows following entities to bill medicare on her behalf.
| Entity Name | Sondermind Provider Network Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1760854442
PECOS PAC ID: 9537572490
Enrollment ID: O20210316002509 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kim Broadnax is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kim Broadnax, LISW
5905 Scarlet Oak Dr,
Bedford Hts, OH 44146-3049
Ph: (216) 536-3134 | Kim Broadnax, LISW
925 Keynote Cir Ste 300,
Brooklyn Hts, OH 44131-1869
Ph: (216) 931-1400 |
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