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BROADSTONE MEDICAL, P.C.
NPI 1366165359
General Practice in Lake Elmo, MN

Active since September 23, 2022
8530 EAGLE POINT BLVD STE 100, LAKE ELMO, MN 55042(231) 432-5841 Get Directions Write a Review

NPPES record last updated: March 26, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 26, 2026, Jan 26, 2026, Dec 17, 2024 and 4 more (7 updates tracked since 2022).

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

NPI1366165359
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameBROADSTONE MEDICAL, P.C.
Location Address8530 EAGLE POINT BLVD STE 100Lake Elmo, MN 55042-8648
Mailing Address222 Lakeview Ave Ste 735West Palm Beach, FL 33401-6145 · (231) 432-5841
Phone(231) 432-5841
Organization SubpartNo
Authorized OfficialNancy HerreraClinical Operations Manager · (920) 915-6995
Enumeration DateSeptember 23, 2022
Last NPPES UpdateMarch 26, 20267 updates tracked since enumeration
NPPES CertifiedMarch 26, 2026
✔ NPI 1366165359 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
8530 EAGLE POINT BLVD STE 100, Lake Elmo, MN 55042
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Secondary Practice Location 1

Location 1500 Ala Moana Blvd Ste 7400Honolulu, HI 96813-4902 · Phone (904) 728-6493

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

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.

WHIT WONDER WISDOM COUNSELING INC
Clinic/Center (Mental Health (Including Community Mental Health Center))
8530 EAGLE POINT BLVD STE 100
LAKE ELMO, MN 55042
Washington County (612) 361-9448
WHITNEY KELTNER WESSELS MSW, LICSW
Social Worker (Clinical)
8530 EAGLE POINT BLVD STE 100
LAKE ELMO, MN 55042
Washington County (763) 328-0606
ABIOLA ADEDIPE
Behavior Technician
8530 EAGLE POINT BLVD STE 100
LAKE ELMO, MN 55042
Washington County (651) 303-7365
VENTHOUSE COUNSELING
Counselor (Mental Health)
8530 EAGLE POINT BLVD STE 100
LAKE ELMO, MN 55042
Washington County (612) 562-6766
DAHIR SALAT
Behavior Technician
8530 EAGLE POINT BLVD STE 100
LAKE ELMO, MN 55042
Washington County (651) 303-7365
ALEXANDER MAAS
Counselor (Mental Health)
8530 EAGLE POINT BLVD STE 100
LAKE ELMO, MN 55042
Washington County (612) 548-1135
AURORA THERAPY SERVICES LLC
Early Intervention Provider Agency
8530 EAGLE POINT BLVD STE 100
LAKE ELMO, MN 55042
Washington County (612) 500-1885
HAMDA DIRRIR
Behavior Technician
8530 EAGLE POINT BLVD STE 100
LAKE ELMO, MN 55042
Washington County (651) 303-7365

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.

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 4 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.