NPIMap

Individual provider Active NPI

Mary E Broughton, PA-C

  • Medical Physician Assistant
  • Crystal, MN
National Provider Identifier
1487844734
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
10288 Issued in MN
Practice address
5109 36TH Ave N
Crystal, MN 55422-2007
Phone
(763) 587-7900
Fax
(763) 587-7989
NPI assigned
Aug 1, 2007
Last updated
Nov 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 10288 MN Primary

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 1

TypeEndpointUseAffiliation
Direct Messaging Address mary.broughton@nor.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070927000290 MN Practitioner - Physician Assistant 9830284421 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
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 PAGroup PAC ID 2769384205, 50 clinicians

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1009MNMDMarriage & Family Therapist
10288MNMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
North Clinic, PA Medical CurrentSince Aug 8, 2007 Accepting new patients
North Memorial Health Care CurrentSince Feb 9, 2010 Accepting new patients
North Memorial Health Care CurrentSince Feb 9, 2010 Accepting new patients
Solace Home Health and Hospice Care Inc Past Accepting new patients
V Kare, PA Past Accepting new patients

Locations

5109 36th Ave N
Minneapolis, MN 55422
Phone (612) 293-7822

9201 W Broadway Ave
Ste 601
Minneapolis, MN 55445
Phone (763) 587-7933

50 Central Ave
Osseo, MN 55369
Phone (612) 588-4625

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

Interoperability endpoints

  • Direct secure messaging: mary.broughton@nor.eclinicaldirectplus.com

Organizations & group practices 6

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 28

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

View all 28

NPI Registry JSON

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

{
    "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

Sources for this page

Verify at the official NPI Registry.