Individual provider Active NPI

Megan Broadwater

  • Nurse Practitioner
  • Cordele, GA
National Provider Identifier
1407539398
Registry record updated Aug 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN283122 Issued in GA
Practice address
902 N 7TH St
Cordele, GA 31015-3234
Phone
(229) 276-3100
NPI assigned
Aug 8, 2023
Last updated
Aug 8, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN283122 GA Primary

Addresses

Primary practice location

902 N 7TH St
Cordele, GA 31015-3234

Mailing address

422 Lower Rebecca Rd
Fitzgerald, GA 31750-8257
Phone (229) 326-9451

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20230925002405 GA Practitioner - Nurse Practitioner 4385098375 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoebe Physician Group IncGroup PAC ID 8426112350, 420 clinicians
Crisp Regional Hospital IncGroup PAC ID 5991616336, 65 clinicians

Practice addresses (Care Compare)

1390 US Hwy 19 S
Leesburg, GA 31763-4831
Phone (229) 312-7490

151 Mayo St
Suite B
Americus, GA 31709-4782
Phone (229) 928-2900

151 Mayo St a
Americus, GA 31709-4782
Phone (229) 312-5800

151 Mayo St C
Americus, GA 31709-4782
Phone (229) 928-2882

151 Mayo St D
Americus, GA 31709-4782
Phone (229) 928-1100

151 Mayo St E
Americus, GA 31709-4782
Phone (229) 931-1159

2336 Dawson Rd
Suite 1600
Albany, GA 31707-2801
Phone (229) 312-8750

902 N 7TH St
Cordele, GA 31015-3234
Phone (229) 276-3100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN283122GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Phoebe Physician Group, Inc CurrentSince Feb 12, 2024 Accepting new patients
Crisp Regional Hospital, Inc CurrentSince Aug 12, 2023 Accepting new patients
Crisp Regional Hospital Inc CurrentSince Aug 12, 2023 Accepting new patients
Crisp County Emergency Medical Services Past Accepting new patients

Locations

2002 Palmyra Rd
Ste 201
Albany, GA 31701
Phone (229) 312-5802

151 Mayo St
Ste B
Americus, GA 31709
Phone (229) 928-2900

902 N 7th St
Cordele, GA 31015
Phone (229) 276-3100

Interoperability endpoints

  • Direct secure messaging: megan.broadwater.1@8478.direct.athenahealth.com
  • Direct secure messaging: megan.broadwater@phoebehealth.gadirect.net

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": "1691452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1407539398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 LOWER REBECCA RD",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508257",
            "telephone_number": "229-326-9451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 N 7TH ST",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153234",
            "telephone_number": "229-276-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWATER",
        "first_name": "MEGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-08",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN283122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordele, GA

Sources for this page

Verify at the official NPI Registry.