Mark A. Broberg, M.D.
Individual provider Active NPI Orthopaedic Surgery Physician · Wenatchee, WA
NPI 1174529804 · NPPES record last updated Jul 14, 2015
Key facts
- NPI
- 1174529804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- MD00022773 (WA)
- Practice address
- 520 N Chelan Ave
Wenatchee, WA 98801-6697 - Phone
- (509) 662-2211
- Fax
- (509) 662-8756
- NPI assigned
- Jun 27, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Saint Louis University School of Medicine, 1980
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
520 N Chelan Ave
Wenatchee, WA 98801-6697
Hospital & facility affiliations
- Confluence Health Hospital
- Quincy Valley Medical Center
- Lake Chelan Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100625000229 | WA | Practitioner - Orthopedic Surgery | 8820129497 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Washington Health Services Association | Current | Accepting new patients | |
| Central Washington Health Services Association | Current |
Accepting new patients | |
| Wenatchee Valley Hospital | Current |
Accepting new patients | |
| Ozark Tri-County Health Care Consortium | Past | Accepting new patients |
Locations
17 S Western Ave
Tonasket, WA 98855
Phone (509) 486-2174
1201 S Miller St
Wenatchee, WA 98801
Phone (509) 662-2208
520 N Chelan Ave
Wenatchee, WA 98801
Phone (509) 662-2211
820 N Chelan Ave
Wenatchee, WA 98801
Phone (509) 863-4868
933 Red Apple Rd
Wenatchee, WA 98801
Phone (509) 655-6125
Interoperability endpoints
- mbroberg18077@edirect.chehr.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | MD00022773 | WA | Yes |
Addresses
Primary practice location
520 N Chelan Ave
Wenatchee, WA 98801-6697
Mailing address
820 N Chelan Ave
Wenatchee, WA 98801-2028
Phone (509) 663-8711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 322544 | Other | WA | WVH LNI |
| P01257508 | Other | WA | RR MEDICARE WVH |
| 1174529804 | Medicaid | WA |
Other providers in Wenatchee, WA
- Aynsley Noel Briggs
- Jonathan W Briggs
- Naomi Felisa Briones
- James Michael Britt
- Katharine Ann Broberg
- Jennifer Lynn Brooks
- Shelbi Brough
- Rocky C Browder
- Brown & Cole Stores LLC
- Ada Lori Brown
All providers in Wenatchee, WA · Orthopaedic Surgery Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.