KELLY C. BRODERICK M.D. – NPI #1609821891
Radiology

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Health Care Provider Taxonomy Code for Radiology

KELLY BRODERICK is a radiologist located in SAN MATEO, CA. NPPES has assigned the NPI number 1609821891 to KELLY BRODERICK on May 24, 2006. It is a Type-1 NPI, indicating this NPI number is associated with an individual. According to the NPI data, there are 2 additional location(s) assigned to this provider which are listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 2085R0202X from the Health Care Provider Taxonomy code set, which is classified as Radiology, specializing in Diagnostic Radiology

The NPI profile was previously updated about 6 years ago on Sep 23, 2020. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for KELLY BRODERICK below.

NPI Profile for
KELLY C. BRODERICK

NPI Number
1609821891
Enumeration Date

(more than 20 years ago)
Entity Type
Type-1  Individual (Female)
Legal Name
KELLY C. BRODERICK
Credentials
M.D.
Primary location
100 S SAN MATEO DR
SAN MATEO, CA 94401-3805
Phone: (650) 696-4515 Fax: (650) 696-4626
2 Other location(s):
1501 Trousdale Dr
Burlingame, CA 94010-4506
Phone: (650) 696-5515
Fax: (650) 696-5280
222 W 39th Ave
San Mateo, CA 94403-4364
Phone: (650) 573-2222
Fax: (650) 573-2122
Mailing address
PO BOX 6102
NOVATO, CA 94948-6102
Phone: (415) 884-3418 Fax: (415) 883-3406
Sole Proprietor
No
Updated
Certification Date
Sep 23, 2020

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for KELLY BRODERICK

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
OTHERBLUE CROSSCA00G787590
OTHERRAILROAD MEDICARECA300121755
OTHERRAILROAD MEDICARECA300121792
MEDICAIDCA00G787590
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2085R0202X
- Radiology / Diagnostic Radiology (Primary)		 CA G78759
2085U0001X
- Radiology / Diagnostic Ultrasound		 CA G78759

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Additional Information

Education
HARVARD MEDICAL SCHOOL - Graduated 1992
Accepts Medicare
This provider accepts Medicare-approved amount as payment in full. The Medicare-approved amount is the total the provider can be paid. When a provider accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible & coinsureance.
Medicare Ordering & Referring
Provider can:
  • Refer to Part B
  • Order Durable Medical Equipment
  • Refer to Home Health Agency
  • Order Power Mobility Devices
Affiliations
KELLY BRODERICK is affiliated with the following medical group(s):
  • HOSPITAL
    • PENINSULA MEDICAL CENTER
      1501 TROUSDALE DRIVE
      BURLINGAME, CA 94010
    • SAN MATEO MEDICAL CENTER
      222 W 39TH AVE
      SAN MATEO, CA 94403

Why is my NPI data (personal information) being displayed publicly?
If you have an active NPI profile, your profile is required to be disclosed according to the FOIA and eFOIA. HIPAA also requires covered providers to share their NPI with other providers, health plans, clearinghouses and any entity that may need it for billing purposes.

How do I correct or change the NPI data displayed here?
At any time, providers can make changes to their NPI profile at NPPES. Login to NPPES to make changes online or call (800) 465-3203 for assistance. Changes made at NPPES will be reflected on this web site within a few days.

Can I hide my NPI profile from the public?
Unfortunately, No. The NPPES discloses health care provider data under the Freedom of Information Act to the public, which means anyone may request such information directly from the National Plan & Provider Enumeration System. See the complete CMS Data Dissemination Notice here.