NPIMap

Individual provider Active NPI

Charles A Broberg, DC, PA,

  • Physician Assistant
  • Sioux Falls, SD
National Provider Identifier
1073672481
Registry record updated Jun 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0922 Issued in SD
Practice address
1600 W 22ND St
Sioux Falls, SD 57105-1521
Phone
(605) 312-1000
Fax
(605) 312-1001
NPI assigned
Dec 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0922 SD Primary
Medical Physician Assistant 363AM0700X 0922 SD

Addresses

Primary practice location

1600 W 22ND St
Sioux Falls, SD 57105-1521

Mailing address

1600 W 22ND St
Sioux Falls, SD 57105-1521
Phone (605) 312-1000

Other practice location 1

415 9th St
Britton, SD 57430-2274
Phone (605) 448-5953

Other identifiers 3

IdentifierTypeStateIssuer
7604240MedicaidSD
0005375OtherSDBCBS
BR021953OtherNDBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141030002244 SD Practitioner - Physician Assistant 7810161551 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford ClinicGroup PAC ID 0244143824, 268 clinicians

Practice addresses (Care Compare)

1020 W 18TH St
Sioux Falls, SD 57104-4707
Phone (605) 328-2663

525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-5635

Hospital & facility affiliations

  • Lifescape Hospital, Sioux Falls, SD, CCN 433300

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
75.87
Promoting interoperability
100
Improvement activities
40
Cost
68.53

Merit-based Incentive Payment System (MIPS)

Final score
85.53 of 100Reported as group
Quality
80.98
Promoting interoperability
100
Improvement activities
40
Cost
70.78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Clinic CurrentSince Dec 8, 2014 Accepting new patients
Sanford Medical Center Physician Assistant CurrentSince Jun 30, 2015 Accepting new patients
Sanford Health Network Physician Assistant CurrentSince Aug 1, 2020 Accepting new patients
Sanford Clinic CurrentSince Dec 8, 2014 Accepting new patients
Sanford Health Network CurrentSince Aug 1, 2020 Accepting new patients
Sanford Medical Center CurrentSince Jun 30, 2015 Accepting new patients
Sanford Health Network Past Accepting new patients
Micko Chiropractic PC Past Accepting new patients
Sanford Clinic Past Accepting new patients
Britton Chiropractic Clinic Past Accepting new patients

Locations

701 3rd Ave S
Clear Lake, SD 57226
Phone (605) 874-2141

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

1500 W 22nd St
Ste 102
Sioux Falls, SD 57105
Phone (605) 328-8800

1600 W 22nd St
Sioux Falls, SD 57105
Phone (605) 312-1000

6110 S Minnesota Ave
Sioux Falls, SD 57108
Phone (605) 328-5800

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592784000000",
    "number": "1073672481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W 22ND ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051521",
            "telephone_number": "605-312-1000",
            "fax_number": "605-312-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W 22ND ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051521",
            "telephone_number": "605-312-1000",
            "fax_number": "605-312-1001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 9th St",
            "address_purpose": "LOCATION",
            "city": "Britton",
            "state": "SD",
            "postal_code": "574302274",
            "country_code": "US",
            "telephone_number": "605-448-5953",
            "fax_number": "605-448-1122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROBERG",
        "first_name": "CHARLES",
        "middle_name": "A",
        "credential": "DC, PA,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0922",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SD",
            "license": "0922",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7604240",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0005375",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "BR021953",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.