Broadway Medical Clinic LLP

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

BROADWAY MEDICAL CLINIC LLP

Practice address

4212 NE Broadway
Portland, OR 97213-1422

Phone

(503) 249-8787

Fax

(503) 284-5168

NPI assigned

Jun 10, 2005

Last updated

Nov 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Heather L Bardfield, RN

Title

Executive Director

Phone

(503) 331-7610

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dennis Earl Bley, D.O.

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1720146152
  Medicare reassignment Care Compare group NPD
• Charles L Darby, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1942376850
  Medicare reassignment Care Compare group NPD
• Benjamin David Ehst, M.D., PH.D.

  • Dermatology Physician
  • Portland, OR
  • NPI 1740320068
  Medicare reassignment Care Compare group NPD
• Tracy Hansen, M.D.

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1326494576
  Medicare reassignment Care Compare group NPD
• Janis L Howatt, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1437225257
  Medicare reassignment Care Compare group NPD
• Marjorie J Hrbek, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1053488718
  Medicare reassignment Care Compare group NPD
• Katherine Lattimer, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
  • NPI 1659923779
  Medicare reassignment Care Compare group NPD
• Michael Mazzotta, M.D.

  • Pediatrics Physician
  • Portland, OR
  • NPI 1841427572
  Medicare reassignment Care Compare group NPD
• Douglas E Renouard, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1568539195
  Medicare reassignment Care Compare group NPD
• Beenish T Shaikh, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1811646250
  Medicare reassignment Care Compare group NPD
• Molly H Tveite, M.D.

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1619171022
  Medicare reassignment Care Compare group NPD
• Charles M Wood, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1902961907
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1720082316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131460",
            "telephone_number": "503-249-8787",
            "fax_number": "503-284-5168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 NE BROADWAY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131422",
            "telephone_number": "503-249-8787",
            "fax_number": "503-284-5168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY MEDICAL CLINIC LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "BARDFIELD",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "503-331-7610",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Michael Broadsword, DMD
• Jonathon Broadwater
• Broadway Cab, LLC (Broadway Cab)
• Broadway Dental, P.C. (dr. goodman-cherrier, p.c.)
• Broadway Foot & Ankle Clinic, PC
• Broadway Physical Therapy & Sports Rehab LLC
• Broadway Vision World
• Craig Stanford Broberg, MD
• Marika Elizabeth Brobisky
• Jessica Caitlin Brocanelli, RDH

• Primary Care Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Primary Care Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.