BRANDEIS BROCKMAN CRNP
NPI 1114289402
Nurse Practitioner - Family in Bala Cynwyd, PA

Q: What is Brandeis Brockman's NPI number?

The NPI number for Brandeis Brockman is 1114289402. It was assigned to this individual provider in the NPPES registry on June 12, 2012.

Q: What is Brandeis Brockman's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Brandeis Brockman was last updated on May 13, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 12, 2012PECOS Enrolled

15 PRESIDENTIAL BLVD, BALA CYNWYD, PA 19004(610) 668-8300 Get Directions Write a Review

NPPES record last updated: May 13, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: May 13, 2026, Feb 19, 2018 (2 updates tracked since 2018).

On this page

About Brandeis Brockman Crnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRANDEIS BROCKMAN CRNP (NPI 1114289402) is an individual family provider in Bala Cynwyd, Pennsylvania, licensed in Pennsylvania (SP012117) and active in the NPI registry since June 2012. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114289402

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameBRANDEIS BROCKMANCredential: CRNP

Location Address15 PRESIDENTIAL BLVDBala Cynwyd, PA 19004-1006

Mailing Address2630 W Girard Ave Unit 9137Philadelphia, PA 19130-1483

Phone(610) 668-8300

Sole ProprietorNo

Enumeration DateJune 12, 2012

Last NPPES UpdateMay 13, 20262 updates tracked since enumeration

NPPES CertifiedMay 13, 2026

✔ NPI 1114289402 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in PA · SP012117

15 PRESIDENTIAL BLVD, Bala Cynwyd, PA 19004

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Brandeis Brockman Crnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19004 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$92.69 typical visit price

range $59.88 – $180.99

Typical copayment $23.17 (range $14.97 – $45.24)

Most-billed visit code 99203

Established Patient

$105.21 typical visit price

range $19.30 – $147.29

Typical copayment $26.30 (range $4.82 – $36.82)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.