Broad Medical Group Inc.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

BROAD MEDICAL GROUP INC.

Practice address

1640 Newport Blvd Ste 300
Costa Mesa, CA 92627-7725

Phone

(949) 720-9848

Fax

(949) 720-9195

NPI assigned

May 10, 2019

Organization subpart

No

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

Authorized official

Name

Jennifer Lauren Broad, MDNPI 1801039821

Title

Ceo/President

Phone

(949) 720-9848

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Lauren Broad, M.D.

  • Obstetrics & Gynecology Physician
  • Costa Mesa, CA
  • NPI 1801039821
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1557446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757116800000",
    "number": "1255997763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 NEWPORT BLVD STE 300",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926277725",
            "telephone_number": "929-720-9848",
            "fax_number": "949-720-9195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 NEWPORT BLVD STE 300",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926277725",
            "telephone_number": "949-720-9848",
            "fax_number": "949-720-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-10",
        "last_updated": "2025-09-06",
        "certification_date": "2025-09-06",
        "status": "A",
        "authorized_official_last_name": "BROAD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LAUREN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "949-720-9848",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Carlos Briseno
• Bristol Park Medical Group
• Bristol Park Medical Group, Inc
• Michelle Chieme Britt, NURSE PRACTITIONER
• Brittany Foster DMD, Inc
• Jennifer Lauren Broad, M.D.
• Kenya Broadnax
• Broadway Chiropractic a Frank Chiropractic Corp
• Michelle Lynne Bronkhorst, D.C.
• Amelia Ruth Bronson

• Obstetrics & Gynecology Physician in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.