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DR. KEVIN WAYNE BRODER MD
NPI 1205885902
Plastic Surgery in San Diego, CA

Active since May 09, 2006PECOS Enrolled
4510 EXECUTIVE DRIVE, SUITE 200, SAN DIEGO, CA 92121(858) 453-7224(858) 453-7268 Get Directions Write a Review

NPPES record last updated: September 5, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Kevin Wayne Broder Md NPPES

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

DR. KEVIN WAYNE BRODER MD (NPI 1205885902) is an individual plastic surgery provider in San Diego, California, licensed in California (A82409) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1205885902
Entity TypeIndividualMale
Primary Taxonomy208200000X
Provider Legal NameDR. KEVIN WAYNE BRODERCredential: MD
Location Address4510 EXECUTIVE DRIVE, SUITE 200San Diego, CA 92121
Mailing Address4510 Executive Drive, Suite 200San Diego, CA 92121 · (858) 453-7224 · Fax (858) 453-7268
Phone(858) 453-7224
Fax(858) 453-7268
Sole ProprietorYes
Enumeration DateMay 9, 2006
Last NPPES UpdateSeptember 5, 2012
✔ NPI 1205885902 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPlastic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208200000X
License✔ Licensed in CA · A82409
Definition
A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.
4510 EXECUTIVE DRIVE, San Diego, CA 92121
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Other Identifiers 3

Medicare UPINI31574CA
Medicare ID-Type UnspecifiedWA82409ACA
Medicaid00A824090CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kevin Wayne Broder 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92121 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
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$76.87 typical visit price
range $20.62 – $151.42
Typical copayment $19.21 (range $5.15 – $37.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

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

KENDALL SHARP
Psychologist (Clinical Child & Adolescent)
4510 EXECUTIVE DRIVE, SUITE 315, MC: 0985
SAN DIEGO, CA 92121
San Diego County (858) 534-8019
GABRIEL SCHNICKEL MD
Transplant Surgery
4510 EXECUTIVE DRIVE, PLAZA 7
SAN DIEGO, CA 92121
San Diego County (858) 657-6487
HANNAH ROVAZZINI LMFT
Marriage & Family Therapist
4510 EXECUTIVE DRIVE
SAN DIEGO, CA 92121
San Diego County (858) 221-0344
MS. SIMAR SINGH
Student in an Organized Health Care Education/Training Program
4510 EXECUTIVE DRIVE
SAN DIEGO, CA 92121
San Diego County (661) 877-2010
DR. KAMBIZ KOHANI DDS
Dentist (General Practice)
4510 EXECUTIVE DRIVE, SUITE #205
SAN DIEGO, CA 92121
San Diego County (858) 622-1007

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 Kevin Broder's NPI number?

The NPI number for Kevin Broder is 1205885902. It was assigned to this individual provider in the NPPES registry on May 9, 2006.

Where is Kevin Broder located?

Kevin Broder practices at 4510 Executive Drive Suite 200, San Diego, CA 92121. The listed phone number is (858) 453-7224.

What is Kevin Broder's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Is Kevin Broder enrolled in Medicare?

Yes. Kevin Broder is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kevin Broder was last updated on September 5, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.