DR. MARK BRODEUR (NPI# 1952389538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952389538 |
| Entity Type | Individual |
| Full Name | DR. MARK BRODEUR |
| Credential | MD |
| Practice Address |
3625 University Blvd S Emergency Dept Jacksonville FL 32216-4207 |
| Mailing Address |
Po Box 860554 Orlando FL 32886-0554 |
| Practice Telephone | 9043463606 |
| Practice Fax Number | 9043460113 |
| Mailing Telephone | 9043463606 |
| Mailing Fax Number | 9043460113 |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2008-07-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
ME0090285 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 269864100 | 05 | |
| FL | BCBS | 44098 | 01 |
| GA | 787365756A | 05 | |
| FL | FLORIDA MEDICAID | 269864100 | 01 |
| FL | RRMCR | P00139639 | 01 |
| RAILROAD MEDICARE | P00139639 | 01 |
| Street Address |
3625 UNIVERSITY BLVD S EMERGENCY DEPT |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32216-4207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588664395 | Karen Elizabeth Anderson | Anesthesiology | 3625 University Blvd S, Jacksonville, FL 32216-4207 | 2005-07-22 |
| 1174122071 | Deleah Rene Pickler | Registered Nurse | 3625 University Blvd S, Jacksonville, FL 32216-4207 | 2020-10-21 |
| 1801401641 | Kara N Cordova | Nurse Anesthetist, Certified Registered | 3625 University Blvd S, Jacksonville, FL 32216-4222 | 2020-09-09 |
| 1174153654 | Marina Follick | Registered Nurse | 3625 University Blvd S, Jacksonville, FL 32216-4207 | 2020-01-23 |
| 1649818337 | Sarah Chapman Farris | Registered Nurse | 3625 University Blvd S, Jacksonville, FL 32216-4207 | 2019-12-13 |
| 1487291837 | Lee Willingham | Registered Nurse | 3625 University Blvd S, Jacksonville, FL 32216-4207 | 2019-12-04 |
| 1609411586 | Kyle Steven Scott | Nurse Anesthetist, Certified Registered | 3625 University Blvd S, Jacksonville, FL 32216-4222 | 2019-11-14 |
| 1982246328 | Amy Marie Suralis | Registered Nurse | 3625 University Blvd S, Jacksonville, FL 32216-4207 | 2019-10-16 |
| 1396391991 | Sarah Siebrandt | Occupational Therapist | 3625 University Blvd S, Jacksonville, FL 32216-4222 | 2019-08-11 |
| 1790347979 | Leda Hansen | Nurse Practitioner | 3625 University Blvd S, Jacksonville, FL 32216-4207 | 2019-07-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524925 | Renee Cherie Titus | Behavior Technician | Growing Together Center 6789 Southpoint Parkway, Building 100, Jacksonville, FL 32216 | 2020-09-24 |
| 1811546575 | First Coast Orthopedic Center, LLC | Clinic/Center | 4035 Southpoint Boulevard, Jacksonville, FL 32216 | 2019-09-05 |
| 1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
| 1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
| 1790279479 | Joseph Richard Kennedy | Physician Assistant | 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 | 2018-06-18 |
| 1801304357 | Kelli M. Tyson | Nurse Practitioner | 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 | 2018-01-18 |
| 1376054809 | Angela M Whittinghill | Counselor | 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 | 2017-10-24 |
| 1629508072 | Zoryana Yufan | Dentist | 8750 Perimeter Park Blvd Ste 101, Jacksonville, FL 32216 | 2017-06-19 |
| 1700318896 | Christina Kaczmarek | Behavior Technician | 6816 Southpoint Pkwy Ste 500, Jacksonville, FL 32216 | 2017-03-29 |
| 1932640422 | Loudine Racius | Nurse Practitioner | 8539 Gate Parkway W, Unit 1422, Jacksonville, FL 32216 | 2017-03-16 |
| Find all providers in zip 32216 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295744639 | Mark A Smith Md,p.a. | Emergency Medicine | 10095 Beach Blvd Ste 300, Jacksonville, FL 32246-4775 | 2006-08-05 |
| 1356329056 | Anthony Edward Hamaty | Emergency Medicine | 14444 Beach Blvd, Suite 305b, Jacksonville, FL 32250-2079 | 2006-01-04 |
| 1184920928 | Christian Glardon | Emergency Medicine | 4311 Salisbury Rd, Jacksonville, FL 32216-6123 | 2011-01-26 |
| 1497080220 | Boss Urgent Care, Pllc | Emergency Medicine | 325 Western Blvd, Jacksonville, NC 28546-6341 | 2009-10-13 |
| 1912132010 | Ian Russell Rowe | Emergency Medicine | 655 W. Eighth St., Clinical Center, 1st Floor, Jacksonville, FL 32209 | 2009-05-19 |
| 1265693279 | University of Florida Jacksonville Physicians Inc | Emergency Medicine | 655 W 8th St, Ufjp Emergency Medicine, Jacksonville, FL 32209-6511 | 2008-06-23 |
| 1831147354 | Jeffrey H Sapolsky | Emergency Medicine | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2006-05-05 |
| 1144278011 | Bradley Berger | Emergency Medicine | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2006-05-04 |
| 1003874363 | Max T Billingsley | Emergency Medicine | 1 Shircliff Way, Emergency Department, Jacksonville, FL 32204-4748 | 2006-05-03 |
| 1013975507 | W Lynn Augenstein | Emergency Medicine | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2006-05-03 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32216 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.