Diana Marie Broadway, APRN-CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

25919 Issued in SC

Practice address

9313 Medical Plaza Dr Ste 202
Charleston, SC 29406-9176

Phone

(843) 572-1200

Fax

(843) 553-0424

NPI assigned

Jun 29, 2021

Last updated

May 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Palmetto Primary Care Physicians, LLC

  dba PPCP Canterbury House

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1073234928
  Medicare reassignment NPD
• Palmetto Primary Care Physicians, LLC

  • Family Medicine Physician
  • Summerville, SC
  • NPI 1366123739
  NPD
• Palmetto Primary Care Physicians, LLC

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1720029713
  NPD

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1265002554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9313 MEDICAL PLAZA DR STE 202",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294069176",
            "telephone_number": "843-572-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9313 MEDICAL PLAZA DR STE 202",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294069176",
            "telephone_number": "843-572-1200",
            "fax_number": "843-553-0424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWAY",
        "first_name": "DIANA",
        "middle_name": "MARIE",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-29",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "216506",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "25919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Brittain
• Carolyn Dolores Britten, MD
• Alexandria Jacqueline Brittingham
• John J Britton Jr., M. D.
• Rebecca Rew Britton, PHARMD
• Jessica Lynn Broadway, MD
• Andrew S. Brock, M.D.
• Clive D Brock, MD
• Marissa Brock
• Matthew Brock, PHARMD

• Family Nurse Practitioner in Charleston, SC
• Providers in Charleston, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.