Lisa Jackson Broyles, MD is a medicare enrolled "Family Medicine" physician in Saluda, North Carolina. Her current practice location is
1347 Ozone Dr, Suite 2, Saluda, North Carolina. You can reach out to her office (for appointments etc.) via phone at
(828) 749-0149.
Lisa Jackson Broyles is licensed to practice in North Carolina (license number 2016-02352) 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 1417081720.
Physician's Profile
Full Name | Lisa Jackson Broyles |
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Gender | Female |
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Speciality | Family Medicine |
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Location | 1347 Ozone Dr, Saluda, North Carolina |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1417081720
- Provider Enumeration Date: 03/16/2007
- Last Update Date: 01/26/2023
Medicare PECOS Information:
- PECOS PAC ID: 8123041639
- Enrollment ID: I20180718002281
Medical Identifiers
Medical identifiers for Lisa Jackson Broyles such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1417081720 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | 2016-02352 (North Carolina) | 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. Lisa Jackson Broyles allows following entities to bill medicare on her behalf.
Entity Name | St. Luke's Hospital Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1497944912 PECOS PAC ID: 1254324585 Enrollment ID: O20050103001010 |
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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. Lisa Jackson Broyles 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 |
Lisa Jackson Broyles, MD Po Box 19305, Charlotte, NC 28219-9305 Ph: () - | Lisa Jackson Broyles, MD 1347 Ozone Dr, Suite 2, Saluda, NC 28773-5506 Ph: (828) 749-0149 |
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