Denisse Guillen Broadbent, M.D.
Individual provider Active NPI Pediatrics Physician · Baxter, MN
NPI 1508399130 · NPPES record last updated Jun 12, 2020
Key facts
- NPI
- 1508399130
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 66589 (MN)
- Practice address
- 13060 Isle Dr
Baxter, MN 56425-8331 - Phone
- (218) 828-2880
- Fax
- (218) 454-5916
- NPI assigned
- Apr 10, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
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: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200629000053 | MN | Practitioner - Pediatric Medicine | 0345662904 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66589 | MN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Joseph'S Medical Center | Current | Accepting new patients | |
| St. Joseph'S Medical Center | Current |
Accepting new patients | |
| St Joseph'S Medical Center | Current |
Accepting new patients |
Locations
523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394
13060 Isle Dr
Brainerd, MN 56425
Phone (218) 454-5920
Interoperability endpoints
- denisse.broadbent@direct.myhealthep.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 66589 | MN | Yes |
Addresses
Primary practice location
13060 Isle Dr
Baxter, MN 56425-8331
Mailing address
1702 University Dr S
Fargo, ND 58103-4940
Other providers in Baxter, MN
- Emily Breitling
- Randy Charles Brenny
- Brighter Day Health LLC
- Kelly Brinkman
- Emily Britton
- Cassandra Marie Brooks
- Tory Elizabeth Brown
- Glenn Alan Browning
- Alexandra Brucker
- Amy Lynn Buchite
All providers in Baxter, MN · Pediatrics Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2020. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.