Active NPI
Christian Edward Brodeur, MD
- Diagnostic Radiology Physician
- Springfield, MO
National Provider Identifier
1871609453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 2007029596
- Practice address
- 3850 S National Ave
Suite 300
Springfield, MO 65807-5287 - Phone
- (417) 269-6170
- Fax
- (417) 269-6992
- NPI assigned
- Aug 23, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | T2004016409 | MO | |
| Diagnostic Radiology Physician | 2085R0202X | 2007029596 | MO | Primary |
Addresses
Primary practice location
3850 S National Ave
Suite 300
Springfield, MO 65807-5287
Mailing address
PO Box 3262
Springfield, MO 65808-3262
Phone (417) 885-3888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 207057605 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- University of Missouri, Columbia School of Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3850 S National Ave
Suite 300
Springfield, MO 65807-5287
Phone (417) 269-6170
Hospital & facility affiliations
- Cox Medical Centers
- Cox Medical Center Branson
- Cox Monett Hospital
- Cox Barton County Hospital
- Mercy Hospital Springfield
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T2004016409 | MO | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians for Breast Health, L.L.C. | Diagnostic Radiology | Current | Accepting new patients |
Locations
29 NW 1st Ln
Lamar, MO 64759
Phone (417) 681-5266
1411 E Primrose St
Ste C
Springfield, MO 65804
Phone (417) 882-1207
3850 S National Ave
Ste 300
Springfield, MO 65807
Phone (417) 269-6170
Interoperability endpoints
- christian.brodeur@cernerdirect.coxhealth.com
Organizations & group practices 1
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.
-
- Diagnostic Radiology Physician
- Springfield, MO
- NPI 1063748929
Hospital & facility affiliations 15
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Lamar, MO
- NPI 1922514629
-
- Critical Access Hospital
- Monett, MO
- NPI 1194757500
-
- General Acute Care Hospital
- Springfield, MO
- NPI 1093740128
-
- General Acute Care Hospital
- Springfield, MO
- NPI 1578504056
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660867200000",
"number": "1871609453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3262",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658083262",
"telephone_number": "417-885-3888",
"fax_number": "417-881-7268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3850 S NATIONAL AVE",
"address_2": "SUITE 300",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658075287",
"telephone_number": "417-269-6170",
"fax_number": "417-269-6992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODEUR",
"first_name": "CHRISTIAN",
"middle_name": "EDWARD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2022-08-19",
"certification_date": "2022-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MO",
"license": "T2004016409",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MO",
"license": "2007029596",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207057605",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; 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.