Michael D Broadwell, PSYD is a medicare enrolled "Psychologist" provider in Rochester, Minnesota. His current practice location is
3535 40th Ave Nw Ste 210, Rochester, Minnesota. You can reach out to his office (for appointments etc.) via phone at
(507) 516-0227.
Michael D Broadwell is licensed to practice in Minnesota (license number LP6869) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1053645119.
Healthcare Provider's Profile
| Full Name | Michael D Broadwell |
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| Gender | Male |
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| Speciality | Psychologist |
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| Location | 3535 40th Ave Nw Ste 210, Rochester, Minnesota |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1053645119
- Provider Enumeration Date: 09/22/2009
- Last Update Date: 12/12/2022
Medicare PECOS Information:
- PECOS PAC ID: 5395081269
- Enrollment ID: I20190114002381
Medical Identifiers
Medical identifiers for Michael D Broadwell such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1053645119 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | LP6869 (Minnesota) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Michael D Broadwell allows following entities to bill medicare on his behalf.
| Entity Name | Hawaii Center For Children And Families, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1194163253
PECOS PAC ID: 8820421589
Enrollment ID: O20191210003298 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Michael D Broadwell is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Michael D Broadwell, PSYD
3535 40th Ave Nw Ste 210,
Rochester, MN 55901-1769
Ph: (507) 516-0227 | Michael D Broadwell, PSYD
3535 40th Ave Nw Ste 210,
Rochester, MN 55901-1769
Ph: (507) 516-0227 |
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