Mary E Broughton, PA-C
Individual provider Active NPI Medical Physician Assistant · Crystal, MN
NPI 1487844734 · NPPES record last updated Nov 7, 2022
Key facts
- NPI
- 1487844734
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 10288 (MN)
- Practice address
- 5109 36TH Ave N
Crystal, MN 55422-2007 - Phone
- (763) 587-7900
- Fax
- (763) 587-7989
- NPI assigned
- Aug 1, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 29
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- North Clinic PA
Practice addresses (Care Compare)
50 Central Ave
Osseo, MN 55369-1241
Phone (763) 587-7900
5109 36TH Ave N
Crystal, MN 55422-2007
Phone (763) 587-7900
9825 Hospital Dr
Suite 300
Maple Grove, MN 55369-4768
Phone (763) 587-7900
Hospital & facility affiliations
- Adara Home Health Inc
- Centerwell Home Health
- North Memorial Health Hospital
- Abbott Northwestern Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- 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 |
|---|---|---|---|---|
| I20070927000290 | MN | Practitioner - Physician Assistant | 9830284421 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10288 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Memorial Health Care | Current |
Accepting new patients | |
| North Memorial Health Care | Current |
Accepting new patients | |
| North Clinic, PA | Current |
Accepting new patients | |
| V Kare, PA | Past | Accepting new patients | |
| Solace Home Health and Hospice Care Inc | Past | Accepting new patients |
Locations
9201 W Broadway Ave
Ste 601
Minneapolis, MN 55445
Phone (763) 587-7933
5109 36th Ave N
Minneapolis, MN 55422
Phone (630) 632-2648
50 Central Ave
Osseo, MN 55369
Phone (612) 588-4625
3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 10288 | MN | Yes |
Addresses
Primary practice location
5109 36TH Ave N
Crystal, MN 55422-2007
Mailing address
9201 W Broadway Ave Ste 601
Brooklyn Park, MN 55445-1924
Phone (763) 587-7900
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mary.broughton@nor.eclinicaldirectplus.com |
NPI Registry JSON
{
"created_epoch": "1185926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667779200000",
"number": "1487844734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9201 W BROADWAY AVE STE 601",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554451924",
"telephone_number": "763-587-7900",
"fax_number": "763-587-7066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5109 36TH AVE N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554222007",
"telephone_number": "763-587-7900",
"fax_number": "763-587-7989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUGHTON",
"first_name": "MARY",
"middle_name": "E",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-01",
"last_updated": "2022-11-07",
"certification_date": "2022-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MN",
"license": "10288",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mary.broughton@nor.eclinicaldirectplus.com",
"affiliation": "N",
"address_1": "5109 36th Ave N",
"city": "Crystal",
"state": "MN",
"country_code": "US",
"postal_code": "55422",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Crystal, MN
- Brody Robert Michael Boeckmann
- Dylan Jordan Bogotty
- Bonnie Michelle Abel Bolash
- Christina A Boryczka
- Emily Boss
- Lauren Elisabeth Bruehl
- Sara Lynn Budhoo
- Sean Burns
- Jennifer Anne Burton
- C&M Dental PLLC
All providers in Crystal, MN · Medical Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2022. 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.