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BROAD MEDICAL GROUP INC.
NPI 1255997763
Obstetrics & Gynecology in Costa Mesa, CA

Active since May 10, 2019
1640 NEWPORT BLVD STE 300, COSTA MESA, CA 92627(949) 720-9848(949) 720-9195 Get Directions Write a Review

NPPES record last updated: September 6, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 6, 2025, May 10, 2019 (2 updates tracked since 2019).

About Broad Medical Group Inc. NPPES

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

BROAD MEDICAL GROUP INC. (NPI 1255997763) is a healthcare organization registered as an obstetrics & gynecology in Costa Mesa, California and active in the NPI registry since May 2019. The organization lists Jennifer Lauren Broad, Ceo/president, as its authorized official.

NPPES Registry Identity

NPI1255997763
Entity TypeOrganization
Primary Taxonomy207V00000X
Legal Business NameBROAD MEDICAL GROUP INC.
Location Address1640 NEWPORT BLVD STE 300Costa Mesa, CA 92627-7725
Mailing Address1640 Newport Blvd Ste 300Costa Mesa, CA 92627-7725 · (929) 720-9848 · Fax (949) 720-9195
Phone(949) 720-9848
Fax(949) 720-9195
Organization SubpartNo
Authorized OfficialJennifer Lauren BroadCeo/president · (949) 720-9848
Enumeration DateMay 10, 2019
Last NPPES UpdateSeptember 6, 20252 updates tracked since enumeration
NPPES CertifiedSeptember 6, 2025
✔ NPI 1255997763 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
1640 NEWPORT BLVD STE 300, Costa Mesa, CA 92627
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Broad Medical Group Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Broad Medical Group Inc., which bills Medicare for the services this clinician delivers.

Clinician (1)

Jennifer Broad, M.D.
Obstetrics/Gynecology
NPI 1801039821
1640 NEWPORT BLVD STE 300
Costa Mesa, CA 92627
(949) 720-9848
✔ PECOS✔ Accepts MedicareSame address

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

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 Broad Medical Group Inc.'s NPI number?

The NPI number for Broad Medical Group Inc. is 1255997763. It was assigned to this organization in the NPPES registry on May 10, 2019.

Where is Broad Medical Group Inc. located?

Broad Medical Group Inc. is located at 1640 Newport Blvd Ste 300, Costa Mesa, CA 92627. The listed phone number is (949) 720-9848.

What is Broad Medical Group Inc.'s specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Broad Medical Group Inc. enrolled in Medicare?

Yes. Broad Medical Group Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Broad Medical Group Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Obstetrics/Gynecology) reassigns their Medicare billing to Broad Medical Group Inc.. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Broad Medical Group Inc. was last updated on September 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months 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.