Kevin Stanley Broaddrick, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

POD-000814 Issued in AZ

Practice address

6739 W Cactus Rd
Peoria, AZ 85381-5311

Phone

(833) 242-0100

Fax

(602) 805-4745

NPI assigned

Aug 5, 2006

Last updated

Aug 11, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25335/brand/1/csg/1/fhir/r4

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.

• Active Vital Care LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1326825092
  Medicare reassignment NPD
• Agave Adult Medical Care LLC

  • Adult Medicine Physician
  • Sedona, AZ
  • NPI 1861153579
  Medicare reassignment NPD
• Angels Valley Community Healthcare Center PLLC

  • Physician Assistant
  • Phoenix, AZ
  • NPI 1689303117
  Medicare reassignment NPD
• Wisconsin Health Fund

  • Dental Clinic/Center
  • Milwaukee, WI
  • NPI 1598951246
  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1639188394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3149 E HAZELTINE WAY",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852499066",
            "telephone_number": "414-702-0954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6739 W CACTUS RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815311",
            "telephone_number": "833-242-0100",
            "fax_number": "602-805-4745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADDRICK",
        "first_name": "KEVIN",
        "middle_name": "STANLEY",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AZ",
            "license": "POD-000814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brightside Wellness LLC
• Karen Brimley, FP
• Ferdinand Briones, MSN,FNP-C
• Lindsey Brister, SLPA
• Brivadental LLC (AZ Cosmetic & Family Dentistry)
• Denise M Brock, PTA
• Taylor Brock, LAC
• Shannon Brodala
• Broken Chains Christian Counseling,Inc.
• Brookdale Senior Living Communities, Inc. (Brookdale Peoria)

• Podiatrist in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Podiatrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; 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.