Jason R Broderick
Behavior Technician in Indianapolis, IN. Individual provider (NPI-1).
NPI number1033729645
StatusActive
Last updated in NPPESAug 7, 2020
Details
- NPI
- 1033729645
- Entity type
- Individual (NPI-1)
- Name
- Jason R Broderick
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 7, 2020
- Certification date
- Aug 7, 2020
- Last updated
- Aug 7, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | RBT-19-82423 | IN | Yes |
Practice location
6925 Parkdale PlIndianapolis, IN 46254-4673
Phone 317-597-4553 · Fax 317-520-8200
Mailing address
3500 Depauw Blvd Ste 3070Indianapolis, IN 46268-6135
Phone 855-324-0885 · Fax 317-520-8200
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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