Active NPI
Bruce Charles Broudy, M.D.
- Pulmonary Disease Physician
- Lexington, KY
National Provider Identifier
1821028481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 18112
- Practice address
- 1225 S. Broadway
Suite 201
Lexington, KY 40504-2701 - Phone
- (859) 258-4568
- Fax
- (859) 258-4698
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | 18112 | KY | Primary |
Addresses
Primary practice location
1225 S. Broadway
Suite 201
Lexington, KY 40504-2701
Mailing address
1225 S. Broadway
Suite 201
Lexington, KY 40504-2701
Phone (859) 258-4568
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ASC1019 | Other | KY | MEDICARE ASC GROUP |
| 37903705 | Other | KY | MEDICAID LAB GROUP |
| 64181126 | Medicaid | KY | |
| 4000501 | Other | KY | MEDICARE LAB GROUP |
| CB5773 | Other | KY | RR MEDICARE GROUP |
| 010056744 | Other | KY | RR MEDICARE PIN |
| 36000818 | Other | KY | MEDICAID ASC GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18112 | KY | MD | Pulmonary Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349827200000",
"number": "1821028481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1225 S. BROADWAY",
"address_2": "SUITE 201",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405042701",
"telephone_number": "859-258-4568",
"fax_number": "859-258-4698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 S. BROADWAY",
"address_2": "SUITE 201",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405042701",
"telephone_number": "859-258-4568",
"fax_number": "859-258-4698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUDY",
"first_name": "BRUCE",
"middle_name": "CHARLES",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2012-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "KY",
"license": "18112",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ASC GROUP",
"identifier": "ASC1019",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID LAB GROUP",
"identifier": "37903705",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64181126",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE LAB GROUP",
"identifier": "4000501",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP",
"identifier": "CB5773",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PIN",
"identifier": "010056744",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID ASC GROUP",
"identifier": "36000818",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.