NPIMap

Andrew D Broadmoore, MD

Individual provider Active NPI Hospitalist Physician · Duluth, MN

NPI 1508828633 · NPPES record last updated Feb 20, 2020

Key facts

NPI
1508828633
Entity type
Individual (NPI type 1)
Primary specialty
Hospitalist Physician 208M00000X
License
46673 (MN)
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Apr 4, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 31

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 31

Hospital & facility affiliations 3

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

Medicare Care Compare profile

Specialty
Hospitalist
Also: Family Practice
Education
University of Minnesota Medical School, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTD (1,135 clinicians)
Unified Therapy Services, Inc (124 clinicians)

Practice addresses (Care Compare)

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-4000

4135 Pennsylvania Ave
Dubuque, IA 52002-2628

502 E 2ND St
Duluth, MN 55805-1913
Phone (218) 786-8364

530 E 2ND St
Duluth, MN 55805-1913
Phone (218) 786-8364

Hospital & facility affiliations

  • Essentia Health St Mary'S Medical Center Hospital · Duluth, MN · CCN 240002
  • Essentia Health Duluth Hospital · Duluth, MN · CCN 240019
  • Essentia Health Virginia Hospital · Virginia, MN · CCN 240084

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MN, WI
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20060221000775 MN Practitioner - Hospitalist
Practitioner - Family Practice		 3173539616 Reassigns benefits to 1 organization
I20200422001575 WI Practitioner - Family Practice
Practitioner - Hospitalist		 3173539616 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
No
HHS exclusion list flag
The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD Current Accepting new patients
St. Mary'S Hospital of Superior Current Accepting new patients
St. Mary'S Hospital of Superior Current
since Mar 1, 2020		 Accepting new patients
The Duluth Clinic, LTD Current
since Mar 16, 2020		 Accepting new patients
The Duluth Clinic, LTD. Current
since Mar 16, 2020		 Accepting new patients
St Marys Medical Center Past Accepting new patients
SMDC Medical Center Past Accepting new patients

Locations

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

4702 Grand Ave
Duluth, MN 55807
Phone (218) 249-6800

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

603 9th St N
Virginia, MN 55792
Phone (218) 741-3013

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 46673 MN Yes

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805-1951

Mailing address

1702 University Dr S
Fargo, ND 58103-4940

Other identifiers

IdentifierTypeStateIssuer
0495960MedicaidIA
18118OtherIAMEDICARE GROUP NUMBER

Other names

  • Andrew Davis Broadwell Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 20, 2020.

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1508828633",
    "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": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADMOORE",
        "first_name": "ANDREW",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MN",
            "license": "46673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0495960",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "18118",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREW",
            "last_name": "BROADWELL",
            "middle_name": "DAVIS",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Duluth, MN

All providers in Duluth, MN · Hospitalist Physician in Minnesota

Sources for this page

Verify at the official NPI Registry.