Active NPI
Jeffrey N Broder MD PC
- Family Nurse Practitioner
- North Augusta, SC
National Provider Identifier
1679567259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APN459
- Legal business name
- JEFFREY N BRODER MD PC
- Practice address
- 1201 West Ave
North Augusta, SC 29841-3350 - Phone
- (803) 279-1030
- Fax
- (803) 278-1344
- NPI assigned
- Sep 9, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jeffrey N Broder, MD
- Title
- Medical Director
- Phone
- (803) 279-1030
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 15157 | SC | |
| Family Nurse Practitioner | 363LF0000X | APN459 | SC | Primary |
Addresses
Primary practice location
1201 West Ave
North Augusta, SC 29841-3350
Mailing address
1201 West Ave
North Augusta, SC 29841-3350
Phone (803) 279-1030
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP2905 | Medicaid | SC |
Other names 1
- North Agusta Urgent Care Family & Occupational Medicine
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126224000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757548800000",
"number": "1679567259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 WEST AVE",
"city": "NORTH AUGUSTA",
"state": "SC",
"postal_code": "298413350",
"telephone_number": "803-279-1030",
"fax_number": "803-278-1344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 WEST AVE",
"city": "NORTH AUGUSTA",
"state": "SC",
"postal_code": "298413350",
"telephone_number": "803-279-1030",
"fax_number": "803-278-1344"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JEFFREY N BRODER MD PC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-09",
"last_updated": "2025-09-11",
"status": "A",
"authorized_official_last_name": "BRODER",
"authorized_official_first_name": "JEFFREY",
"authorized_official_middle_name": "N",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "803-279-1030",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "General Practice",
"state": "SC",
"license": "15157",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "SC",
"license": "APN459",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP2905",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "North Agusta Urgent Care Family & Occupational Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in North Augusta, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.