PROF. STACI BROADWELL PSY.D
NPI 1467696419
Psychologist - Clinical in Phoenix, AZ

Q: What is Staci Broadwell's NPI number?

The NPI number for Staci Broadwell is 1467696419. It was assigned to this individual provider in the NPPES registry on April 21, 2009. The provider is also known as Staci Davis Psy.D.

Q: What is Staci Broadwell's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Staci Broadwell was last updated on June 12, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 21, 2009PECOS EnrolledAccepts Medicare Assignment

87.81/100

CMS Quality Rating

3830 E VAN BUREN ST, PHOENIX, AZ 85008(602) 243-7277(602) 286-0808 Get Directions Write a Review

NPPES record last updated: June 12, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 12, 2024, Oct 26, 2017 (2 updates tracked since 2017).

On this page

About Prof. Staci Broadwell Psy.d NPPES

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

PROF. STACI BROADWELL PSY.D (NPI 1467696419) is an individual clinical provider in Phoenix, Arizona, licensed in Arizona (4519) and active in the NPI registry since April 2009. She is enrolled in Medicare PECOS and is a graduate of Other (2005).

NPPES Registry Identity

NPI1467696419

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NamePROF. STACI BROADWELLCredential: PSY.D

Location Address3830 E VAN BUREN STPhoenix, AZ 85008-6920

Mailing Address2702 N 3rd St Ste 4020Phoenix, AZ 85004-4608 · (602) 323-3492 · Fax (602) 323-3399

Phone(602) 243-7277

Fax(602) 286-0808

Sole ProprietorNo

Medical School CMSOtherGraduated 2005

Enumeration DateApril 21, 2009

Last NPPES UpdateJune 12, 20242 updates tracked since enumeration

✔ NPI 1467696419 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Licenses✔ Licensed in AZ · 4519✔ Licensed in NY · 017898

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

3830 E VAN BUREN ST, Phoenix, AZ 85008

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Other Names 1

Former Name (1)Staci Davis Psy.d

Other Identifiers 1

Medicaid206766AZ

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Prof. Staci Broadwell Psy.d is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1254637747

PECOS Enrollment IDI20171220003298

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 85008 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

$168.60 typical visit price

range $55.44 – $168.60

Typical copayment $42.15 (range $13.86 – $42.15)

Most-billed visit code 99205

Established Patient

$98.00 typical visit price

range $17.72 – $137.41

Typical copayment $24.50 (range $4.43 – $34.35)

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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

87.81/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Promoting Interoperability

Improvement Activities

Cost

61.22

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHELLE GALSTER

Social Worker (Clinical)