Jeffrey N Broder, MD
Individual provider Active NPI Family Medicine Physician · North Augusta, SC
NPI 1992799563 · NPPES record last updated May 27, 2010
Key facts
- NPI
- 1992799563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 15157 (SC)
- Practice address
- 1201 West Ave
North Augusta, SC 29841-3350 - Phone
- (803) 279-1030
- Fax
- (803) 278-1344
- NPI assigned
- Sep 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150604002757 | GA | Order and Referring Only - General Practice |
9739137746 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15157 | SC | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 15157 | SC | |
| Family Medicine Physician | 207Q00000X | 15157 | SC | Yes |
| Occupational Medicine Physician | 2083X0100X | 15157 | SC |
Addresses
Primary practice location
1201 West Ave
North Augusta, SC 29841-3350
Mailing address
1201 West Ave
North Augusta, SC 29841-3350
Phone (803) 279-1030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G30017 | Medicaid | SC |
Other providers in North Augusta, SC
- Brantley Chiropractic, PC
- Abigail Brantley
- Andrea M Breazeale
- Joy Elizabeth Britt
- Shannon E Brockwell
- Brookdale Senior Living Communities, Inc
- Frances Elaine Brooks
- Samuel Chase Brooks
- Jean Rochelle Brown
- Jeanora Brown
All providers in North Augusta, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.