KELLY CLARK BRODERICK M.D. NPI 1609821891

NPI Information

  • NPI: 1609821891
  • Provider Name: KELLY CLARK BRODERICK, M.D.
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 100 S SAN MATEO DR
    SAN MATEO, CA
    ZIP 94401
  • Phone: (650) 696-4515

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NPI Details

Kelly Clark Broderick, M.D. is a diagnostic radiology radiology in San Mateo, CA with 34 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Kelly Clark Broderick, M.D. NPI is 1609821891. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: HARVARD MEDICAL SCHOOL
Graduation Year:1992

The provider's business location address is:

100 S SAN MATEO DR
SAN MATEO, CA
ZIP 94401-805
Phone: (650) 696-4515
Fax: (650) 696-4626

The NPI 1609821891 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Screening mammography (HCPCS:77067)
  • Screening 3d breast mammography (HCPCS:77063)
  • X-ray of chest, 1 view (HCPCS:71045)
  • Complete ultrasound scan of 1 breast (HCPCS:76641)
  • Dxa bone density measurement of hip, pelvis, spine (HCPCS:77080)
  • Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) (HCPCS:G0279)
  • Limited ultrasound scan of abdomen (HCPCS:76705)
  • Diagnostic mammography of 1 breast (HCPCS:77065)
  • Complete ultrasound scan behind abdominal cavity (HCPCS:76770)
  • Dxa bone density measurement of forearm, finger, hand, or foot (HCPCS:77081)
  • Ct scan head or brain without contrast (HCPCS:70450)
  • X-ray of chest, 2 views (HCPCS:71046)
  • Ultrasound scan of head and neck soft tissue (HCPCS:76536)
  • Diagnostic mammography of both breasts (HCPCS:77066)
  • Limited ultrasound scan of 1 breast (HCPCS:76642)
  • Complete ultrasound scan of abdomen (HCPCS:76700)
  • Complete ultrasound scan of pelvis (HCPCS:76856)
  • Ct scan of abdomen and pelvis with contrast (HCPCS:74177)
  • Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina (HCPCS:76830)
  • Ct scan of abdomen and pelvis without contrast (HCPCS:74176)
  • X-ray of hip, 2-3 views (HCPCS:73502)
  • X-ray of shoulder, minimum of 2 views (HCPCS:73030)
  • Complete ultrasound scan behind abdominal cavity (HCPCS:76770)
  • Mri scan of both breasts (HCPCS:77049)
  • X-ray of knee, 4 or more views (HCPCS:73564)
  • X-ray of knee, 3 views (HCPCS:73562)
  • Ct scan of chest without contrast (HCPCS:71250)
  • X-ray of abdomen, 1 view (HCPCS:74018)
  • Ultrasound scan of head and neck soft tissue (HCPCS:76536)
  • Ct scan of blood vessels of chest with contrast (HCPCS:71275)
  • X-ray of wrist, minimum of 3 views (HCPCS:73110)
  • X-ray of lower and sacral spine, 2-3 views (HCPCS:72100)

The enumeration date for this NPI number is 5/24/2006 and was last updated on 9/23/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085U0001XRadiologyDiagnostic UltrasoundG78759CALIFORNIANo
22085R0202XRadiologyDiagnostic RadiologyG78759CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100G787590MEDICAIDCALIFORNIA
2300121755OTHERCALIFORNIARAILROAD MEDICARE
300G787590OTHERCALIFORNIABLUE CROSS
4300121792OTHERCALIFORNIARAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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