Prof Staci Broadwell, PSYD in Phoenix, AZ - Medicare Clinical Psychologist Provider

Prof Staci Broadwell, PSYD is a medicare enrolled "Psychologist - Clinical" provider in Phoenix, Arizona. She graduated from medical school in 2005 and has 20 years of diverse experience with area of expertise as Clinical Psychologist. She is a member of the group practice Banner Physician Specialists Arizona Llc and her current practice location is 3830 E Van Buren St, Phoenix, Arizona. You can reach out to her office (for appointments etc.) via phone at (602) 243-7277.

Prof Staci Broadwell is licensed to practice in Arizona (license number 4519) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1467696419.

Contact Information

	Prof Staci Broadwell, PSYD
	3830 E Van Buren St, Phoenix, AZ 85008-6920
	(602) 243-7277
	(602) 286-0808

Map and Direction

Healthcare Provider's Profile

Full Name	Prof Staci Broadwell
Gender	Female
Speciality	Clinical Psychologist
Experience	20 Years
Location	3830 E Van Buren St, Phoenix, Arizona
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Prof Staci Broadwell graduated from medical school in 2005

NPI Data:

NPI Number: 1467696419
Provider Enumeration Date: 04/21/2009
Last Update Date: 06/12/2024

Medicare PECOS Information:

PECOS PAC ID: 1254637747
Enrollment ID: I20171220003298

Medical Identifiers

Medical identifiers for Prof Staci Broadwell such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1467696419	NPI	-	NPPES
206766	Medicaid	AZ

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103TC0700X	Psychologist - Clinical	017898 (New York)	Secondary
103TC0700X	Psychologist - Clinical	4519 (Arizona)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Banner Physician Specialists Arizona Llc	6204002272	255

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. Prof Staci Broadwell allows following entities to bill medicare on her behalf.

Entity Name	Banner Physician Specialists Arizona Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1316228802 PECOS PAC ID: 6204002272 Enrollment ID: O20111222000509

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. Prof Staci Broadwell 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
Prof Staci Broadwell, PSYD 2702 N 3rd St Ste 4020, Phoenix, AZ 85004-4608 Ph: (602) 323-3492	Prof Staci Broadwell, PSYD 3830 E Van Buren St, Phoenix, AZ 85008-6920 Ph: (602) 243-7277

Reviews and Comments

Psychologist in Phoenix, AZ

Dr. Carolyn J Cavanaugh Toft, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 202 E Earll Dr, Suite 420, Phoenix, AZ 85012 Phone: 480-329-6791 Fax: 602-279-0297
Marcia C Diederich, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 25250 N 35th Ave, Phoenix, AZ 85083 Phone: 623-445-7100 Fax: 623-445-7180
Melissa Ann Lake, PSY.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 4552 W Cottontail Rd, Phoenix, AZ 85086 Phone: 201-232-9916
Dr. Brian M Mcdonald, PSYD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3450 N 3rd St, Phoenix, AZ 85012 Phone: 602-957-2507 Fax: 602-265-8533
Efrat Eichenbaum, LP, PHD Psychologist Medicare: Medicare Enrolled Practice Location: 222 W Thomas Rd Ste 401, Phoenix, AZ 85013 Phone: 602-406-3473 Fax: 602-406-4406
Amanda Aaron Hackwell, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 11431 N 39th Pl, Phoenix, AZ 85028 Phone: 541-646-6442
Dr. Ronald L. Willcoxon, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 18647 N 20th Street, Phoenix, AZ 85024 Phone: 602-867-9660 Fax: 602-867-2762

Prof Staci Broadwell, PSYD - Medicare Psychologist in Phoenix, AZ