NPIMap

Individual provider Active NPI

Matthew J Broghammer, DO

  • Surgery Physician
  • Winona, MN
National Provider Identifier
1124038773
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
45674 Issued in MN
Practice address
855 Mankato Ave
Winona, MN 55987-4868
Phone
(507) 454-3680
NPI assigned
Aug 8, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 10

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 8

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

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Winona Health Services 160 clinicians

Practice addresses (Care Compare)

855 Mankato Ave
Winona, MN 55987-4868
Phone (507) 454-3650

Hospital & facility affiliations

  • Winona Health Services Hospital, Winona, MN, CCN 240044
  • Gundersen Lutheran Medical Center Hospital, La Crosse, WI, CCN 520087

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy50
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux40
Varicose vein removal1-10
Removal of tissue12
Skin biopsy1-10

Medicare participation

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

All facility ownership & control disclosures 4

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Winona Health ServicesWinona, MN, CCN 240044 Hospital Corporate Director Jan 1, 2007
Winona Health ServicesWinona, MN, CCN 24U044 Hospital Corporate Director Jan 1, 2007
Lake Winona ManorWinona, MN, CCN 245240 Skilled nursing facility Corporate Director Jan 1, 2007
Winona Area Hospice ServicesWinona, MN, CCN 241535 Hospice Corporate Director Jan 1, 2007

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20040406000259 MN Practitioner - General Surgery 6103819156 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
45674MNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Jun 28, 2016 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Jun 28, 2016 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc Current Accepting new patients
Winona Health Services CurrentSince Oct 1, 2009 Accepting new patients
Winona Health Services Past Accepting new patients

Locations

1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531

420 E Sarnia St
Winona, MN 55987
Phone (507) 454-3680

855 Mankato Ave
Winona, MN 55987
Phone (507) 454-3680

859 Mankato Ave
Winona, MN 55987
Phone (507) 454-3680

420 E Sarnia St
Ste 2500
Winona, MN 55987

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 45674 MN Primary

Addresses

NPPES NPI Registry

Primary practice location

855 Mankato Ave
Winona, MN 55987-4868

Mailing address

855 Mankato Ave
Winona, MN 55987-4868
Phone (507) 454-3680

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
028891800MedicaidMN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 13, 2011.

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1124038773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 MANKATO AVE",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559874868",
            "telephone_number": "507-454-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 MANKATO AVE",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559874868",
            "telephone_number": "507-454-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROGHAMMER",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "45674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "028891800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winona, MN

Sources for this page

Verify at the official NPI Registry.