Organization Active NPI

Jeffrey N Broder MD PC

  • Family Nurse Practitioner
  • North Augusta, SC
National Provider Identifier
1679567259
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN459 Issued in SC
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

Updated by the provider on Sep 11, 2025

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)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X 15157 SC
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 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

IdentifierTypeStateIssuer
GP2905MedicaidSC

Other names 1

  • North Agusta Urgent Care Family & Occupational Medicine Doing business as

National Provider Directory

National Provider Directory

NPI 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.

Verify at the official NPI Registry.