Kristina P Broderick, PA-C
Individual provider Active NPI Physician Assistant · Indianapolis, IN
NPI 1346864527 · NPPES record last updated Sep 19, 2023
Key facts
- NPI
- 1346864527
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 10421 E County Road 100 N
Indianapolis, IN 46234-1243 - Phone
- (317) 272-7013
- Fax
- (317) 272-7007
- NPI assigned
- Jun 3, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- American Health Network of Indiana LLC
Practice addresses (Care Compare)
10421 E County Rd 100
Indianapolis, IN 46234-1243
Phone (317) 272-7013
10995 Allisonville Rd
Suite 100
Fishers, IN 46038-2616
Phone (317) 842-7928
8607 E US Hwy 36
Avon, IN 46123-7960
Hospital & facility affiliations
- Iu Health West Hospital
- Indiana University Health
- Hendricks Regional Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230609002946 | IN | Practitioner - Physician Assistant | 3173909298 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Health Network of Indiana LLC | Current |
Accepting new patients | |
| American Health Network of Indiana, LLC | Current |
Accepting new patients | |
| American Health Network of Indiana, LLC | Past | Accepting new patients | |
| American Health Network of Indiana, LLC | Past | Accepting new patients |
Locations
12174 N Meridian St
Ste 100
Carmel, IN 46032
Phone (317) 208-3866
10995 Allisonville Rd
Ste 100
Fishers, IN 46038
Phone (317) 842-7928
7440 Woodland Dr
Indianapolis, IN 46278
Phone (317) 450-3357
10421 E County Road 100 N
Indianapolis, IN 46234
Phone (317) 272-7013
Interoperability endpoints
- kbroderick209547@direct.optum.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
10421 E County Road 100 N
Indianapolis, IN 46234-1243
Mailing address
10421 E County Road 100 N
Indianapolis, IN 46234-1243
Phone (317) 272-7013
Other providers in Indianapolis, IN
- Ross Brockunier
- Amanda V Broderick
- Conor Thomas Broderick
- Jason R Broderick
- Jill Marie Broderick
- Margaret Therese Broderick
- Thaddeus Broderick
- Lauren Elizabeth Brodeur
- Jerica Nichole Brodhead
- Christopher John Brodowicz
All providers in Indianapolis, IN · Physician Assistant in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.