Kelly Clark Broderick, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G78759 Issued in CA

Practice address

100 S San Mateo Dr
San Mateo, CA 94401-3805

Phone

(650) 696-4515

Fax

(650) 696-4626

NPI assigned

May 24, 2006

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Diagnostic Radiology

Education

Harvard Medical School, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

California Advanced Imaging Medical Associates IncGroup PAC ID 0244144228, 85 clinicians

Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

County of San MateoGroup PAC ID 9032023171, 316 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peninsula Medical Center Hospital, Burlingame, CA, CCN 050007
• San Mateo Medical Center Hospital, San Mateo, CA, CCN 050113
• Stanford Health Care Hospital, Stanford, CA, CCN 050441
• UCSF Medical Center Hospital, San Francisco, CA, CCN 050454
• California Pacific Medical Ctr-Davies Campus Hosp Hospital, San Francisco, CA, CCN 050008

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 33)

Interoperability endpoints

• Direct secure messaging: kbroderick21499@smch.direct-ci.com

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.

• California Advanced Imaging Medical Associates Inc

  • Diagnostic Radiology Physician
  • San Francisco, CA
  • NPI 1881646909
  Medicare reassignment Care Compare group NPD
• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1679642326
  Medicare reassignment Care Compare group NPD
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  Medicare reassignment Care Compare group NPD
• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986

  Diagnostic Radiology

  Medicare reassignment NPD
• County of San Mateo

  • Public Health or Welfare Agency
  • San Mateo, CA
  • NPI 1306907928
  NPD
• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1831268580
  NPD
• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1841369592
  NPD
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Orinda, CA
  • NPI 1366898538

  Diagnostic Radiology

  NPD
• Sutter Bay Medical Foundation

  • Clinical Medical Laboratory
  • Santa Clara, CA
  • NPI 1669287033
  NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD
• Sutter East Bay Medical Foundation

  • Family Medicine Physician
  • Orinda, CA
  • NPI 1871538769

  Diagnostic Radiology

  NPD (past)
• Sutter North Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Yuba City, CA
  • NPI 1144251521
  NPD (past)

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

• County of San Mateo

  • General Acute Care Hospital
  • San Mateo, CA
  • NPI 1003985755
  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Daly City, CA
  • NPI 1023196011

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Daly City, CA
  • NPI 1265522619

  Hospital

  Care Compare affiliation
• County of San Mateo

  • General Acute Care Hospital
  • San Mateo, CA
  • NPI 1386713030
  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Redwood City, CA
  • NPI 1386728533

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Redwood City, CA
  • NPI 1568540557

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • South San Francisco, CA
  • NPI 1750460671

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Half Moon Bay, CA
  • NPI 1841379765

  Hospital

  Care Compare affiliation
• Stanford Health Care

  • Radiation Oncology Physician
  • Pleasanton, CA
  • NPI 1124561758

  Hospital

  Care Compare affiliation
• Stanford Health Care

  • General Acute Care Hospital
  • Emeryville, CA
  • NPI 1275076325
  Care Compare affiliation
• Stanford Health Care

  • General Acute Care Hospital
  • Emeryville, CA
  • NPI 1285177337
  Care Compare affiliation
• Stanford Health Care

  • General Acute Care Hospital
  • Stanford, CA
  • NPI 1437292927
  Care Compare affiliation

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1609821891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6102",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949486102",
            "telephone_number": "415-884-3418",
            "fax_number": "415-883-3406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S SAN MATEO DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013805",
            "telephone_number": "650-696-4515",
            "fax_number": "650-696-4626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 W 39th Ave",
            "address_purpose": "LOCATION",
            "city": "San Mateo",
            "state": "CA",
            "postal_code": "944034364",
            "country_code": "US",
            "telephone_number": "650-573-2222",
            "fax_number": "650-573-2122",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 Trousdale Dr",
            "address_purpose": "LOCATION",
            "city": "Burlingame",
            "state": "CA",
            "postal_code": "940104506",
            "country_code": "US",
            "telephone_number": "650-696-5515",
            "fax_number": "650-696-5280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "KELLY",
        "middle_name": "CLARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CA",
            "license": "G78759",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G78759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G787590",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300121792",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00G787590",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300121755",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Brink, M.D.
• Brianna Briseno
• Jonathan Garth Briskin, M.D.
• Matilde Brito, LCSW
• Alexis Mary Jane Brizuela-Loredo
• Barbara Joann Brodie, NP
• Rosa Brody, MD
• Megan Broome
• Lauren Brouillard
• Brandi N Brown

• Diagnostic Radiology Physician in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.