Individual provider Active NPI

Michael L Broadbent, D.O.

  • Anesthesiology Physician
  • Logan, UT
National Provider Identifier
1285684050
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
377158-1204 Issued in UT
Practice address
274 N Main St
Logan, UT 84321-3915
Phone
(435) 753-1600
Fax
(435) 753-9521
NPI assigned
May 11, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 377158-1204 UT Primary

Addresses

Primary practice location

274 N Main St
Logan, UT 84321-3915

Mailing address

274 N Main St
Logan, UT 84321-3915
Phone (435) 753-1600

Other identifiers 1

IdentifierTypeStateIssuer
870550181001MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20060114000081 UT Practitioner - Anesthesiology 4880618016 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of North Texas HSC, College of Osteopathic Med, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interwest Anesthesia Associates LLCGroup PAC ID 0042293359, 29 clinicians

Practice addresses (Care Compare)

2380 N 400
North Logan, UT 84341-6000
Phone (435) 713-9700

55 E Golf Course Rd
Logan, UT 84321-0001
Phone (435) 760-3734

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
377158-1204UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Adult Services CurrentSince Feb 1, 2015 Accepting new patients
Interwest Anesthesia Associates LLC Anesthesiology CurrentSince Jun 24, 2002 Accepting new patients

Locations

274 N Main St
Logan, UT 84321
Phone (435) 213-9278

55 E Golf Course Rd
Logan, UT 84321
Phone (435) 760-3734

810 S 100 W
Ste 120
Logan, UT 84321
Phone (435) 527-2100

560 W 465 N
Ste 604
Providence, UT 84332
Phone (435) 753-1600

65 N Gateway Dr
Ste 3
Providence, UT 84332
Phone (435) 213-6563

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1285684050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 N MAIN ST",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843213915",
            "telephone_number": "435-753-1600",
            "fax_number": "435-753-9521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "274 N MAIN ST",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843213915",
            "telephone_number": "435-753-1600",
            "fax_number": "435-753-9521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADBENT",
        "first_name": "MICHAEL",
        "middle_name": "L",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "377158-1204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870550181001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.