BROADSTONE MEDICAL, P.C.
NPI 1366165359
General Practice in Lake Elmo, MN
About Broadstone Medical, P.c. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BROADSTONE MEDICAL, P.C. (NPI 1366165359) is a healthcare organization registered as a general practice in Lake Elmo, Minnesota and active in the NPI registry since September 2022. The organization maintains a secondary practice location in Honolulu and lists Nancy Herrera, Clinical Operations Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Broadstone Medical, P.c. 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 Broadstone Medical, P.C., which bills Medicare for the services this clinician delivers.
Clinician (1)
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 Broadstone Medical, P.C.'s NPI number?
The NPI number for Broadstone Medical, P.C. is 1366165359. It was assigned to this organization in the NPPES registry on September 23, 2022.
Where is Broadstone Medical, P.C. located?
Broadstone Medical, P.C. is located at 8530 Eagle Point Blvd Ste 100, Lake Elmo, MN 55042. The listed phone number is (231) 432-5841.
What is Broadstone Medical, P.C.'s specialty?
The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.
Is Broadstone Medical, P.C. enrolled in Medicare?
Yes. Broadstone Medical, P.C. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Broadstone Medical, P.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Broadstone Medical, 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Broadstone Medical, P.C. was last updated on March 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Broadstone Medical, P.c. · NPI 1366165359
General Practice organization in Lake Elmo, Minnesota. Organization record, active in the CMS NPPES registry since September 23, 2022.
## Identity
- **NPI:** 1366165359 (Entity type: Organization)
- **Enumerated:** September 23, 2022
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **Organization subpart:** No
- **Authorized official:** Nancy Herrera, CLINICAL OPERATIONS MANAGER
## Practice location
- **Address:** 8530 EAGLE POINT BLVD STE 100, Lake Elmo, MN 55042-8648
- **Phone:** (231) 432-5841
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Internal Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 26, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1366165359) · Data from the CMS NPPES public registry.