Mark Brodeur, MD

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

ME0090285 Issued in FL

Practice address

3625 University Blvd S
Emergency Dept
Jacksonville, FL 32216-4207

Phone

(904) 346-3606

Fax

(904) 346-0113

NPI assigned

Jan 4, 2006

Last updated

Jul 30, 2008By the provider in NPPES

Sex

Male

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 6

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Emergency Medicine

Education

Eastern Virginia Medical School, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Physicians IncGroup PAC ID 7911811435, 105 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Flagler Hospital Hospital, Saint Augustine, FL, CCN 100090
• Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

98

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mbrodeur742093@direct.shands.ufl.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emergency Physicians Inc

  dba Emergency Resources Group

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1285686675
  Medicare reassignment Care Compare group NPD
• Emergency Physicians Inc

  dba Emergency Resource Group

  • Emergency Medicine Physician
  • Brunswick, GA
  • NPI 1477001972
  NPD
• Florida Em-I Medical Services PA

  • Nurse Practitioner
  • Lighthouse Point, FL
  • NPI 1831531581
  NPD (past)
• Florida Em-I Medical Services, PA

  • Emergency Medicine Physician
  • Tallahassee, FL
  • NPI 1083046049
  NPD (past)
• Doctors for Emergency Service

  • Emergency Medicine Physician
  • Newark, DE
  • NPI 1750369674
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Flagler Hospital Inc

  • General Acute Care Hospital
  • St Augustine, FL
  • NPI 1144211020
  Care Compare affiliation
• Flagler Hospital, Inc.

  • Urgent Care Clinic/Center
  • St Augustine, FL
  • NPI 1447527965

  Hospital

  Care Compare affiliation
• Southern Baptist Hospital of Florida Inc

  dba Baptist Medical Center

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1578620449
  Care Compare affiliation

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217376000000",
    "number": "1952389538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860554",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328860554",
            "telephone_number": "904-346-3606",
            "fax_number": "904-346-0113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "address_2": "EMERGENCY DEPT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-346-3606",
            "fax_number": "904-346-0113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODEUR",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2008-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "FL",
            "license": "ME0090285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA MEDICAID",
            "identifier": "269864100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "787365756A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR",
            "identifier": "P00139639",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269864100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00139639",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "44098",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Broderick, MD
• Jill Erin Broderick, MA
• Megan Leigh Broderick
• Samantha Lee Broderick, BCBA
• Mark Brodersen, MD
• Jacqueline Brodskaya, DMD
• Kiya Jane Brody
• Justine A Broecker, M.D.
• Kelly Lynne Broekhof, BSN
• Nyel Brogden

• Emergency Medical Services (Emergency Medicine) Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; 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.

Verify at the official NPI Registry.