M Physicians Broadway Family Medicine Clinic – Primary Care Clinic/Center, NPI 1366589962
Primary Care Clinic/Center
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for M Physicians Broadway Family Medicine Clinic
720 WASHINGTON AVE SE STE 200
MINNEAPOLIS, MN 554142924
Phone: (612) 884-0600
Type: Mailing
2426 W BROADWAY AVE
MINNEAPOLIS, MN 554111735
Phone: (612) 302-8200
Fax: (612) 302-8275
Type: Location
6300, Shingle Creek Parkway, Brooklyn Center, Hennepin County, Minnesota, 55430, United States
STE 600
BROOKLYN CENTER, MN 554302124
Phone: (763) 782-6400
Fax: (763) 782-9558
Type: Mailing
1020, West Broadway Avenue, Near North, Minneapolis, Hennepin County, Minnesota, 55411, United States
BROADWAY FAMILY MEDICINE
MINNEAPOLIS, MN 55411
Phone: (612) 302-8200
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-02-29 (834 days ago).
Enrollment records
1
Earliest due date
2024-02-29
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20031104000532 | O | Clinic/Group Practice | MN | 2024-02-29 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55414)
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