MATTHEW A BROOM MD
NPI 1114967767
Pediatrics in St. Louis, MO

Q: What is Matthew Broom's NPI number?

The NPI number for Matthew Broom is 1114967767. It was assigned to this individual provider in the NPPES registry on June 8, 2006.

Q: What is Matthew Broom's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Matthew Broom was last updated on July 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 08, 2006PECOS Enrolled

1465 S GRAND BLVD, ST. LOUIS, MO 63104(314) 268-4070(314) 268-4021 Get Directions Write a Review

NPPES record last updated: July 28, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 28, 2023, Jan 18, 2021, May 28, 2019 (3 updates tracked since 2019).

On this page

About Matthew A Broom Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MATTHEW A BROOM MD (NPI 1114967767) is an individual pediatrics provider in St. Louis, Missouri, licensed in Missouri (2006004155) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS and maintains a secondary practice location in Saint Louis.

NPPES Registry Identity

NPI1114967767

Entity TypeIndividualMale

Primary Taxonomy208000000X

Provider Legal NameMATTHEW A BROOMCredential: MD

Location Address1465 S GRAND BLVDSt. Louis, MO 63104-1003

Mailing Address1465 S Grand BlvdSaint Louis, MO 63104-1003 · (314) 268-4070 · Fax (314) 268-4021

Phone(314) 268-4070

Fax(314) 268-4021

Sole ProprietorNo

Enumeration DateJune 8, 2006

Last NPPES UpdateJuly 28, 20233 updates tracked since enumeration

NPPES CertifiedJuly 28, 2023

✔ NPI 1114967767 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in MO · 2006004155

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Also ListedPediatrics · Pediatric Emergency MedicineTaxonomy 2080P0204X · License 2006004155 (MO)

1465 S GRAND BLVD, St. Louis, MO 63104

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Secondary Practice Location 1

Location 1660 Mason Ridge Center DrSaint Louis, MO 63141-8509 · Phone (314) 273-6481

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Matthew A Broom Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Matthew Broom reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Fairview Heights Medical Group Sc

13 mi

Multi-Specialty

670 MASON RIDGE CENTER DR STE 300
Saint Louis, MO 63141

Reassigned Medicare billing, Missouri enrollment
140 clinicians in this Medicare group

NPI 1679503668 (314) 996-7644

Ssm Cardinal Glennon Childrens Hospital

13 mi

Pediatrics

2927 S . KINGS HIGHWAY BLVD
Saint Louis, MO 63139

Reassigned Medicare billing, Missouri enrollment
Medicare enrollment name: Ssm Cardinal Glennon Children's Hospital
414 clinicians in this Medicare group

NPI 1073568226 (314) 268-4070

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$86.32 typical visit price

range $55.65 – $169.38

Typical copayment $21.58 (range $13.91 – $42.34)

Most-billed visit code 99203

Established Patient

$98.37 typical visit price

range $17.76 – $137.92

Typical copayment $24.59 (range $4.44 – $34.48)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

1 supplier12 claims12 services$69.89 avg. paid by Medicare

Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing K0738

DME-Oxygen and Supplies · category DC000N

1 supplier12 claims12 services$34.29 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SARAH MARGARET HANLY PH.D.

Psychologist (Clinical)

1465 S GRAND BLVD
SAINT LOUIS, MO 63104

St. Louis City (314) 577-5667

KAVIPRIYA KOMESWARAN

Pediatrics (Pediatric Critical Care Medicine)

1465 S GRAND BLVD
SAINT LOUIS, MO 63104

St. Louis City (314) 617-2000

ALEXIS HAAS STEWART

Anesthesiologist Assistant

1465 S GRAND BLVD
SAINT LOUIS, MO 63104

St. Louis City (314) 977-5700

NATALIE DRURY RD, LD

Dietitian, Registered (Nutrition, Pediatric)

1465 S GRAND BLVD
SAINT LOUIS, MO 63104

St. Louis City (314) 577-5387

MS. MASHAL AZIZ RANA MBBS

Student in an Organized Health Care Education/Training Program

1465 S GRAND BLVD
ST.LOUIS, MO 63104

St. Louis City (314) 577-5382

TIMOTHY J KUTZ MD

Pediatrics (Child Abuse Pediatrics)

1465 S GRAND BLVD
SAINT LOUIS, MO 63104

St. Louis City (314) 268-6406

CHRISTOPHER SALLEE MD

Pediatrics

1465 S GRAND BLVD
ST. LOUIS, MO 63104

St. Louis City (314) 577-1607

AMBER GRANA DO

Pediatrics (Pediatric Critical Care Medicine)

1465 S GRAND BLVD, DIVISION OF PEDIATRIC CRITICAL CARE
SAINT LOUIS, MO 63104

St. Louis City (314) 577-5695

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Matthew Broom's NPI number?

The NPI number for Matthew Broom is 1114967767. It was assigned to this individual provider in the NPPES registry on June 8, 2006.

Where is Matthew Broom located?

Matthew Broom practices at 1465 S Grand Blvd, St. Louis, MO 63104. The listed phone number is (314) 268-4070.

What is Matthew Broom's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Matthew Broom enrolled in Medicare?

Yes. Matthew Broom is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Matthew Broom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Matthew Broom reassigns Medicare benefits to 2 organizations: Fairview Heights Medical Group Sc (Saint Louis, MO) and Ssm Cardinal Glennon Childrens Hospital (Saint Louis, MO). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Matthew Broom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Matthew Broom was last updated on July 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.