Kathleen L.S. Broadman, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD151194 Issued in OR

Practice address

2500 NE Neff Rd
Bend, OR 97701-6015

Phone

(541) 706-6892

Fax

(541) 706-6869

NPI assigned

Aug 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OR

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kbroadman26602@secure.stcharleshealthcare.org

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.

• Bend Memorial Clinic PC

  • Family Medicine Physician
  • Bend, OR
  • NPI 1699827477
  Medicare reassignment NPD
• St. Charles Health System, Inc.

  • General Acute Care Hospital
  • Bend, OR
  • NPI 1982621447
  Medicare reassignment NPD
• Bend Memorial Clinic PC

  • Clinical Medical Laboratory
  • Bend, OR
  • NPI 1972144913
  NPD
• St. Charles Health System, Inc.

  • Rehabilitation Hospital Unit
  • Bend, OR
  • NPI 1154343150
  NPD
• St. Charles Health System, Inc.

  • Psychiatric Hospital Unit
  • Bend, OR
  • NPI 1154506814
  NPD
• St. Charles Health System, Inc.

  • Rural Health Clinic/Center
  • Prineville, OR
  • NPI 1407178528
  NPD (past)
• St. Charles Health System, Inc.

  • Critical Access Hospital
  • Prineville, OR
  • NPI 1710160445
  NPD (past)
• St. Charles Health System, Inc.

  • Clinical Social Worker
  • Bend, OR
  • NPI 1780698696
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1801909791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6095",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977086095",
            "telephone_number": "541-706-5922",
            "fax_number": "541-706-6869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016015",
            "telephone_number": "541-706-6892",
            "fax_number": "541-706-6869"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1080 Mount Bachelor Dr",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977023280",
            "country_code": "US",
            "telephone_number": "541-550-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROADMAN",
        "first_name": "KATHLEEN",
        "middle_name": "L.S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD151194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500622958",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbroadman4586@directmsg.bmctotalcare.com",
            "affiliation": "N",
            "address_1": "1080 Mount Bachelor Dr",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977023280",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbroadman26602@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2500 NE Neff Rd",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977016015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shannon Melyn Brister, B.A.
• Bristol Hospice - Bend, L.L.C.
• Chrissy Britt
• Amy Elizabeth Brizee
• Lori Suzanne Brizee, RD
• Maleea Brocious
• Amy Kathryn Brock
• Suzanne Lynn Brock
• Antoinette Brockman, O.T.
• Charles Edman Brockman, PT

• Pediatrics Physician in Bend, OR
• Providers in Bend, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; 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.