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
Last updated
Dec 13, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

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

Specialties & licenses 1

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

Addresses

Primary practice location

855 Mankato Ave
Winona, MN 55987-4868

Mailing address

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

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.

Enrollment records 1

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

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 ServicesGroup PAC ID 8527977420, 160 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

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

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

420 E Sarnia St
Ste 2500
Winona, MN 55987

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

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

Ownership & related parties

All facility ownership & control disclosures 4

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

Owned or controlled facilities with NPI records 4

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

Organizations & group practices 5

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

Hospital & facility affiliations 8

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": "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winona, MN

Sources for this page

Verify at the official NPI Registry.