Jaya R Madhav (NPI# 1770970048, PAC ID# 5193030138) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1770970048 |
| PAC ID by PECOS | 5193030138 |
| Professional Enrollment ID | I20181108000820 |
| Full Name | Jaya R Madhav |
| Organization Legal Name | BROADWAY MEDICAL CLINIC LLP |
| Address |
4212 Ne Broadway Portland OR 97213-1422 |
| Phone Number | 5032498787 |
| Gender | F |
| Medical School | UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE |
| Graduation Year | 2015 |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 2466447610 |
| Number of Group Practice Members | 18 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 380038 | PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER |
| 380061 | PROVIDENCE PORTLAND MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 4212 Ne Broadway, Portland, OR 97213-1422 | 5032498787 | BROADWAY MEDICAL CLINIC LLP |
| Organization Legal Name | BROADWAY MEDICAL CLINIC LLP |
| Physicians | 18 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Marjorie J Hrbek | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Mary Lee Baker | Pediatric Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Lorelei Elizabeth Ditommaso | Dermatology | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Tracy L Hansen | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Anne M Hirsch | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Laurel L Simon | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Janis L Howatt | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Clytie S Rimberg | Dermatology | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Douglas E Renouard | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Dennis E Bley | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Street Address |
4212 NE BROADWAY |
| City | PORTLAND |
| State | OR |
| Zip | 97213-1422 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Marjorie J Hrbek | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Mary Lee Baker | Pediatric Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Lorelei Elizabeth Ditommaso | Dermatology | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Tracy L Hansen | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Anne M Hirsch | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Laurel L Simon | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Janis L Howatt | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Clytie S Rimberg | Dermatology | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Douglas E Renouard | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Dennis E Bley | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John R Lewis | Optometry | Beaumont Vision, PC | 4331 Ne Fremont St, Portland, OR 97213-1151 |
| David M Klipper | Diagnostic Radiology | Kern Radiology Medical Group Inc | 4231 Ne Siskiyou St, Portland, OR 97213-1161 |
| Evonne N Serpa | Qualified Audiologist | 4311 Ne Tillamook St, Portland, OR 97213-1315 | |
| Judith J Chambers | Clinical Social Worker | 1804 Ne 45th Ave, Portland, OR 97213-1416 | |
| Diane Squire Hyde | Clinical Social Worker | 1804 Ne 45th Ave, Portland, OR 97213-1416 | |
| Katherine M Kilkenny | Nurse Practitioner | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Michael Grandfield Mazzotta | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Charles M Wood | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| John E Bauer | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Charles L Darby | Internal Medicine | Broadway Medical Clinic LLP | 4212 Ne Broadway, Portland, OR 97213-1422 |
| Find all physicians in zip 97213 | |||
| City | PORTLAND |
| Zip Code | 97213 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | PORTLAND + INTERNAL MEDICINE |
Please comment or provide details below to improve the information on Jaya R Madhav.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.