Peter Broderick, M.D., M.ED.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G63629 Issued in CA

Practice address

401 Paradise Rd
Suite E
Modesto, CA 95351-3104

Phone

(209) 558-4000

Fax

(209) 558-5036

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Family Practice

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Davis Hospital Hospital, Davis, CA, CCN 050537

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Education

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pbroderick20797@hisp.ehr.sutterhealth.org

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

• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  Medicare reassignment Care Compare group NPD
• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986

  Family Medicine

  Medicare reassignment Care Compare group NPD
• County of Stanislaus

  • Clinic/Center
  • Turlock, CA
  • NPI 1831394998
  Medicare reassignment NPD
• County of Stanislaus

  • Rural Health Clinic/Center
  • Hughson, CA
  • NPI 1366648016
  NPD
• County of Stanislaus

  • Community/Behavioral Health Agency
  • Modesto, CA
  • NPI 1902765993
  NPD
• Sutter Bay Medical Foundation

  • Clinical Medical Laboratory
  • Santa Clara, CA
  • NPI 1669287033
  NPD
• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Fairfield, CA
  • NPI 1184859894

  Family Medicine

  NPD
• Ahmc Greater El Monte Comm Hosp LLC

  • Community/Retail Pharmacy
  • South El Monte, CA
  • NPI 1922115526
  NPD (past)
• Doctors Medical Center of Modesto, Inc.

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1184654923
  NPD (past)
• Southern Monterey County Memorial Hospital

  • Critical Access Hospital
  • King City, CA
  • NPI 1114917564
  NPD (past)
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1699129601
  NPD (past)
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Sacramento, CA
  • NPI 1811946734
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Davis, CA
  • NPI 1770532608
  Care Compare affiliation

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1285645002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD",
            "address_2": "SUITE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PARADISE RD",
            "address_2": "SUITE E",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953513104",
            "telephone_number": "209-558-4000",
            "fax_number": "209-558-5036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "M.D., M.ED.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G63629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stanley D. Brizendine, CRNA
• Ricardo Marcelo Brizuela, MD
• Rebecca J. Brock, M.D.
• Salinea Rose Brock
• Tracy Lee Brockman, M.D.
• Renette A Bronken, RN
• Laura Ruth Brooke
• Ciara Brooks
• Jasmine Dominique Brooks, ATS
• Kayshaun Latoya Brooks, LVN

• Family Medicine Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; 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.