MEDICARE: BROSSFIELD MEDICAL GROUP PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1295686301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROSSFIELD MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	11656 BEARPAW MEADOW AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6287
Country	:	US
Telephone Number	:	760-567-8208
Fax Number	:

Provider Business Practice Location Address
First Line	:	11656 BEARPAW MEADOW AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6287
Country	:	US
Telephone Number	:	760-567-8208
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERALYN ELLICE BROSSFIELD
Credential	:	MD
Telephone Number	:	760-567-8208

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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