Michael Broder

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

317878 Issued in NC

Practice address

1011 Rock Quarry Rd
Raleigh, NC 27610-3825

Phone

(919) 833-3111

NPI assigned

Apr 7, 2020

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 NC, LA2 enrollments

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 2

Specialty

Family Practice

Education

Warren Alpert Medical School of Brown University, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Thomas Community Health Center IncGroup PAC ID 8527163211, 40 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St. Thomas Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • New Orleans, LA
  • NPI 1003185125
  Medicare reassignment Care Compare group NPD
• Advance Community Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Raleigh, NC
  • NPI 1245223783
  Medicare reassignment NPD
• St. Thomas Community Health Center, Inc

  • Community/Retail Pharmacy
  • New Orleans, LA
  • NPI 1417786062
  NPD
• St. Thomas Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • New Orleans, LA
  • NPI 1699115600
  NPD
• St. Thomas Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • New Orleans, LA
  • NPI 1194247825
  NPD (past)

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1700415072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 ROCK QUARRY RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276103825",
            "telephone_number": "919-833-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 ROCK QUARRY RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276103825",
            "telephone_number": "919-833-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODER",
        "first_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-07",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "317878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Michelle Brock, M.S. CCC-SLP
• Meissa Davis Brock, LCAS
• Robert Hudgins Brock, LPC-A
• Catherine Brocker
• Kristin Carol Brockman, NP-C
• Allison Kay Porter Broderick, PA
• Whitney Brodie
• Gemma Kate Brodney, RBT
• Mindy Beth Brodsky, LCSWA, LCSW, ESQ.
• Kathryn Laine Brody, MS, RD, LDN

• Family Medicine Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.
• 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.