Physician Compare National (NPI:1457551228)

HEALTHCARE PROVIDER: STEVEN JARED BROADWAY M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1457551228
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810166923
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200106001544
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BROADWAY
	Individual professional last name
Provider First Name	STEVEN
	Individual professional first name
Provider Middle Name	JARED
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	NEUROSURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2829 UNIVERSITY DR S
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	FARGO
	Group Practice or individual's city
State	ND
	Group Practice or individual's state
Zip Code	581036050
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	350070
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ESSENTIA HEALTH
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y