Kali A Broussard, MD
Individual provider Active NPI Pediatric Infectious Diseases Physician · Maurice, LA
NPI 1023549409 · NPPES record last updated Jul 24, 2023
Key facts
- NPI
- 1023549409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Infectious Diseases Physician 2080P0208X
- License
- 338039 (LA)
- Practice address
- 9610 Maurice Ave
Maurice, LA 70555-3255 - Phone
- (337) 470-3131
- Fax
- (337) 470-3315
- NPI assigned
- Mar 27, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230807002008 | LA | Practitioner - Pediatric Medicine | 8325317803 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 338039 | LA | MD | Pediatrics Physician |
| 35.139496 | OH | MD | Pediatric Emergency Medicine (Pediatrics) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lourdes Physician Group LLC | Current |
Accepting new patients | |
| Our Lady of the Lake Physician Group LLC | Current |
Accepting new patients | |
| Our Lady of the Lake Physician Group, LLC | Current |
Accepting new patients | |
| Our Lady of the Lake Physician Group LLC | Pediatrics | Current | Accepting new patients |
| Our Lady of Lourdes Regional Medical Center, Inc | Past | Accepting new patients | |
| Nationwide Children'S Hospital | Past | Accepting new patients |
Locations
8200 Constantin Blvd
Fl 4
Baton Rouge, LA 70809
8200 Constantin Blvd
Fl 3
Baton Rouge, LA 70809
Phone (225) 765-1982
5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011
4809 Ambassador Caffery Pkwy
Ste 410
Lafayette, LA 70508
Phone (337) 470-3109
4704 Ambassador Caffery Pkwy
Lafayette, LA 70508
Phone (337) 470-5920
4600 Ambassador Caffery Pkwy
Lafayette, LA 70508
Phone (337) 371-3135
4801 Ambassador Caffery Pkwy
Lafayette, LA 70508
Phone (337) 470-2000
Interoperability endpoints
- kbroussard16572@direct.casso.us.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 338039 | LA | |
| Pediatrics Physician | 208000000X | 35.139496 | OH | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | 35.139496 | OH | |
| Pediatric Infectious Diseases Physician | 2080P0208X | 338039 | LA | Yes |
Addresses
Primary practice location
9610 Maurice Ave
Maurice, LA 70555-3255
Mailing address
5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (337) 470-3131
Other practice location 1
4363 All Seasons Dr Ste 100
Hilliard, OH 43026-2050
Phone (614) 355-5900
Other practice location 2
700 Childrens Dr
Columbus, OH 43205-2664
Phone (614) 722-2000
Other practice location 3
7901 Diley Rd Ste 150
Canal Winchester, OH 43110-9613
Phone (614) 355-9050
Other practice location 4
7450 Hospital Dr Ste 100
Dublin, OH 43016-8364
Phone (614) 355-7000
Other practice location 5
6435 E Broad St
Columbus, OH 43213-1507
Phone (614) 355-8100
Other practice location 6
100 Colemans Xing
Marysville, OH 43040-7080
Phone (937) 578-7600
Other practice location 7
8200 Constantin Blvd Fl 4
Baton Rouge, LA 70809-3481
Phone (225) 765-5500
Other practice location 8
433 N Cleveland Ave
Westerville, OH 43082-8095
Phone (614) 355-8300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0468063 | Medicaid | OH |
Other providers in Maurice, LA
- Arkansas Elder Outreach of Little Rock, Inc.
- Cher Yan Aymond
- Emily Barousse Alleman
- Gabrielle Mire Black
- Amanda Percle Broussard
- Kimberly Epperly Broussard
- Latasha Broussard
- Nicholas Paul Broussard
- Jordan Clavier
- Alaina Dartez
All providers in Maurice, LA · Pediatric Infectious Diseases Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.