Mary Broderick Christensen, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G72502 Issued in CA

Practice address

15000 Arnold Dr
Eldridge, CA 95431-8900

Phone

(707) 938-6690

NPI assigned

May 17, 2006

Last updated

Dec 19, 2011By the provider in NPPES

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 names 1

• Mary Angela Pearl Broderick Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• State of California - Department of Developmental Services

  dba Lanterman Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Pomona, CA
  • NPI 1093085565
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324252800000",
    "number": "1982656724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 9TH ST",
            "address_2": "ROOM 205 MAILSTOP 23",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958146414",
            "telephone_number": "916-654-2431",
            "fax_number": "916-654-2431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15000 ARNOLD DR",
            "city": "ELDRIDGE",
            "state": "CA",
            "postal_code": "954318900",
            "telephone_number": "707-938-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTENSEN",
        "first_name": "MARY",
        "middle_name": "BRODERICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2011-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G72502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "BRODERICK",
            "middle_name": "ANGELA PEARL",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Timothy Wallace Kaczmar, M.D.
• Brian S Pecha, MD
• State of California - Department of Developmental Services

• Family Medicine Physician in Eldridge, CA
• Providers in Eldridge, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.