BROADWAY INTERNAL MEDICINE P.C
NPI 1124265848
Clinic/Center - Community Health in Elmhurts, NY
About Broadway Internal Medicine P.c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BROADWAY INTERNAL MEDICINE P.C (NPI 1124265848) is a healthcare organization registered as a community health in Elmhurts, New York and active in the NPI registry since January 2009. The organization holds a CLIA Waiver certificate valid through September 8, 2027 and lists Carlos Manuel Gonzalez, Physician, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Broadway Internal Medicine P.c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Broadway Internal Medicine P.C, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 33D2065419
Broadway Internal Medicine PC · Elmhurst, NYFrequently 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 Broadway Internal Medicine P.C's NPI number?
The NPI number for Broadway Internal Medicine P.C is 1124265848. It was assigned to this organization in the NPPES registry on January 16, 2009.
Where is Broadway Internal Medicine P.C located?
Broadway Internal Medicine P.C is located at 7517 41st Avenue, Elmhurts, NY 11373. The listed phone number is (718) 803-6300.
What is Broadway Internal Medicine P.C's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Community Health, with taxonomy code 261QC1500X.
Is Broadway Internal Medicine P.C enrolled in Medicare?
Yes. Broadway Internal Medicine P.C is registered in the Medicare PECOS enrollment system.
When is Broadway Internal Medicine P.C's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New York, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Broadway Internal Medicine P.C?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Internal Medicine, reassign their Medicare billing to Broadway Internal Medicine P.C. A 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 the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Broadway Internal Medicine P.C hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 33D2065419) is associated with this NPI, valid through September 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Broadway Internal Medicine P.C was last updated on January 16, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.
# Broadway Internal Medicine P.c · NPI 1124265848
Community Health organization in Elmhurts, New York. Organization record, active in the CMS NPPES registry since January 16, 2009.
## Identity
- **NPI:** 1124265848 (Entity type: Organization)
- **Enumerated:** January 16, 2009
- **Primary specialty:** Clinic/Center - Community Health · taxonomy 261QC1500X
- **Organization subpart:** No
- **Authorized official:** Carlos Gonzalez, PHYSICIAN
## Practice location
- **Address:** 7517 41ST AVENUE, Elmhurts, NY 11373
- **Phone:** (718) 803-6300 · **Fax:** (718) 803-0085
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, New York, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians (Internal Medicine) reassign Medicare billing to this organization (form CMS-855R); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 16, 2009
- **Other identifiers:** Medicaid 1437162024 (NY)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1124265848) · Data from the CMS NPPES public registry.