IDA ELISE BROADWATER CRNP
NPI 1598195307
Nurse Practitioner - Adult Health in Philadelphia, PA
About Ida Elise Broadwater Crnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IDA ELISE BROADWATER CRNP (NPI 1598195307) is an individual adult health provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (SP013545) and active in the NPI registry since November 2013. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ida Elise Broadwater Crnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 19104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
PHILADELPHIA, PA 19104
PHILADELPHIA, PA 19104
PHILADELPHIA, PA 19104
PHILADELPHIA, PA 19104
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Ida Broadwater's NPI number?
The NPI number for Ida Broadwater is 1598195307. It was assigned to this individual provider in the NPPES registry on November 14, 2013.
Where is Ida Broadwater located?
Ida Broadwater practices at 3400 Spruce Street 6 Silverstein, Philadelphia, PA 19104. The listed phone number is (215) 615-4949.
What is Ida Broadwater's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.
Is Ida Broadwater enrolled in Medicare?
Yes. Ida Broadwater is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Ida Broadwater was last updated on December 20, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.
# Ida Elise Broadwater, CRNP · NPI 1598195307
Adult Health physician in Philadelphia, Pennsylvania. Individual provider, active in the CMS NPPES registry since November 14, 2013.
## Identity
- **NPI:** 1598195307 (Entity type: Individual)
- **Enumerated:** November 14, 2013
- **Primary specialty:** Nurse Practitioner - Adult Health · taxonomy 363LA2200X
- **State license:** SP013545 (Pennsylvania)
- **Sole proprietor:** No
## Practice location
- **Address:** 3400 SPRUCE STREET, 6 SILVERSTEIN, Philadelphia, PA 19104
- **Phone:** (215) 615-4949
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** December 20, 2013
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Source: [NPI Profile](https://npiprofile.com/npi/1598195307) · Data from the CMS NPPES public registry.