Broadstone Medical, P.C.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

BROADSTONE MEDICAL, P.C.

Practice address

8530 Eagle Point Blvd Ste 100
Lake Elmo, MN 55042-8648

Phone

(231) 432-5841

NPI assigned

Sep 23, 2022

Organization subpart

No

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

Authorized official

Name

Nancy Herrera

Title

Clinical Operations Manager

Phone

(920) 915-6995

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 3

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

• Sandeep Palakodeti, M.D., M.P.H.

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1568738649

  NY

  Medicare reassignment NPD
• Sherri Lane Horvat, FNP-BC

  • Family Nurse Practitioner
  • Griffith, IN
  • NPI 1790462851
  NPD (past)
• Ana Caroline Teles Remigio, FNP

  • Family Nurse Practitioner
  • Colton, CA
  • NPI 1346791761
  NPD (past)

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

{
    "created_epoch": "1663891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774483200000",
    "number": "1366165359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 LAKEVIEW AVE STE 735",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334016145",
            "telephone_number": "231-432-5841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8530 EAGLE POINT BLVD STE 100",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550428648",
            "telephone_number": "231-432-5841"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Ala Moana Blvd Ste 7400",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968134902",
            "country_code": "US",
            "telephone_number": "904-728-6493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BROADSTONE MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-23",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A",
        "authorized_official_last_name": "HERRERA",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CLINICAL OPERATIONS MANAGER",
        "authorized_official_telephone_number": "920-915-6995"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariel J Blomstrand, MSW LICSW
• Blossom Towne Enterprises
• Carolyn Marie Bollinger, LICSW
• Mari Boyd, M.A., LMFT
• John Arthur Bragstad, LMFT
• Kent Gregory Brockmann, MD
• Alexandra Nicole Brown, MA, LPCC
• Emily Clara Jindra Cable, DPT
• Bruce Douglas Campbell, DDS
• Amee Natvar Chandrabalan, D.O.

• General Practice Physician in Lake Elmo, MN
• Providers in Lake Elmo, MN by specialty
• General Practice Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; 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.