Tara L Broadwater, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

40655 Issued in MN

Practice address

898 Wescott TRL Apt 311
Eagan, MN 55123-2272

Phone

(507) 304-1899

NPI assigned

Jan 10, 2006

Last updated

Apr 26, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

86.56 of 100Reported as group

Quality

74.25

Promoting interoperability

100

Improvement activities

40

Cost

76.16

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Sanford Health of Northern Minnesota

  dba Sanford Health Kelliher Clinic

  • Family Medicine Physician
  • Kelliher, MN
  • NPI 1770849697
  Medicare reassignment NPD
• Sanford Health of Northern Minnesota

  dba Sanford Health Behavioral Health Administration Office

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bemidji, MN
  • NPI 1427567601
  NPD
• Sanford Health of Northern Minnesota

  dba Joe Lueken Cancer Center

  • Internal Medicine Physician
  • Bemidji, MN
  • NPI 1780628149

  Family Medicine

  NPD
• Sanford Health of Northern Minnesota

  dba Sanford Bemidji Behavioral Health

  • Psychiatric Hospital Unit
  • Bemidji, MN
  • NPI 1649902370
  NPD (past)

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1255310298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "898 WESCOTT TRL APT 311",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551232272",
            "telephone_number": "507-304-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "898 WESCOTT TRL APT 311",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551232272",
            "telephone_number": "507-304-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWATER",
        "first_name": "TARA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-10",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "40655",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "40655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "0573816",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "388R8BU",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFFERED ONE",
            "identifier": "NA2951032151",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526011600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "124673",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP36174",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00138242",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAS PPO",
            "identifier": "1965380",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "41084933956001C212",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Logan Brinn, PHARMD
• Jamie Briski
• Karen Brisky
• Lance Gary Brisky, D.C.
• Kenneth Britton, D.O.
• Laura Evavold Broder, M.D.
• Michael Lee Broeker, MD
• Colette R Brogan, OT
• Abbie Lynn Broman
• Brookdale Senior Living Communities, Inc. (Clare Bridge of Eagan)

• Psychiatry Physician in Eagan, MN
• Providers in Eagan, MN by specialty
• Psychiatry Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.