Peter H Broekelschen MD Inc

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

A25076 Issued in CA

Legal business name

PETER H BROEKELSCHEN MD INC

Practice address

1441 Avocado Ave
Suite 607
Newport Beach, CA 92660

Phone

(949) 759-1042

Fax

(949) 759-0143

NPI assigned

Aug 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Peter H Broekelschen, MDNPI 1366631525

Title

President Owner

Phone

(949) 759-1042

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter Broekelschen, MD

  • Gastroenterology Physician
  • Newport Beach, CA
  • NPI 1366631525
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1861501561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 AVOCADO AVE",
            "address_2": "SUITE 607",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "92660",
            "telephone_number": "949-759-1042",
            "fax_number": "949-759-0143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 AVOCADO AVE",
            "address_2": "SUITE 607",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "92660",
            "telephone_number": "949-759-1042",
            "fax_number": "949-759-0143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER H BROEKELSCHEN MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "BROEKELSCHEN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "949-759-1042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A25076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Perry
• Colleen Perry(Young), M.S
• Personal Healthcare
• Sandra Vandoren Pertz, M.D.
• Peter C Wang MD Inc
• Peter Helton Professional Corporation
• Ross M Peters, D.D.S.
• Andrea Rae Petersen, MPH, PA-C
• Angela Peterson
• Samuel R Peterson, MD

• Gastroenterology Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; 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.