Denisse Guillen Broadbent, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

66589 Issued in MN

Practice address

13060 Isle Dr
Baxter, MN 56425-8331

Phone

(218) 828-2880

Fax

(218) 454-5916

NPI assigned

Apr 10, 2017

Last updated

Jun 12, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: denisse.broadbent@direct.myhealthep.org

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.

• St. Joseph's Medical Center

  dba Essentia Health-St. Joseph's Medical Center

  • General Acute Care Hospital
  • Brainerd, MN
  • NPI 1568415974
  Medicare reassignment NPD
• St Joseph's Medical Center

  dba Essentia Health St Josephs Staples Clinic

  • Multi-Specialty Clinic/Center
  • Staples, MN
  • NPI 1538916101
  NPD
• St. Joseph's Medical Center

  dba Essentia Health St. Joseph's -Brainerd Clinic

  • General Practice Physician
  • Brainerd, MN
  • NPI 1184866956
  NPD

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591920000000",
    "number": "1508399130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13060 ISLE DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258331",
            "telephone_number": "218-828-2880",
            "fax_number": "218-454-5916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADBENT",
        "first_name": "DENISSE",
        "middle_name": "GUILLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-10",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "66589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Breitling
• Randy Charles Brenny, PHARM D
• Brighter Day Health LLC
• Kelly Brinkman, LMFT
• Emily Britton
• Cassandra Marie Brooks
• Tory Elizabeth Brown
• Glenn Alan Browning, MA LMFT
• Alexandra Brucker
• Jacob S Brusehaver, OTR

• Pediatrics Physician in Baxter, MN
• Providers in Baxter, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.