NPIMap

Individual provider Active NPI

Gerald B Broussard Jr., MD

  • Diagnostic Radiology Physician
  • Hattiesburg, MS
National Provider Identifier
1104117688
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
24982 Issued in MS
Practice address
6051 U S Highway 49
Hattiesburg, MS 39401-7200
Phone
(800) 494-8260
Fax
(859) 368-0437
NPI assigned
May 2, 2011
Last updated
May 6, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R2826 KY
Student in an Organized Health Care Education/Training Program 390200000X
Addiction Medicine (Internal Medicine) Physician 207RA0401X R2826 KY
Diagnostic Radiology Physician 2085R0202X 24982 MS Primary

Addresses

Primary practice location

6051 U S Highway 49
Hattiesburg, MS 39401-7200

Mailing address

5000 W 4TH St
Hattiesburg, MS 39402-1000
Phone (800) 494-8260

Other practice location 1

178 Highway 24 E
Centreville, MS 39631-4171
Phone (601) 890-0500

Other identifiers 1

IdentifierTypeStateIssuer
07124262MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170524002825 MS Practitioner - Diagnostic Radiology 1850604802 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Tulane University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Field Memorial Community HospitalGroup PAC ID 0547248544, shared by 7 NPIs, 41 clinicians
Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians
Comprehensive Radiology Services PLLCGroup PAC ID 1759364946, 50 clinicians

Practice addresses (Care Compare)

178 Hwy 24 E
Centreville, MS 39631-4171
Phone (601) 890-0500

40 Union Church Rd
Meadvile, MS 39653-8336
Phone (601) 384-2273

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 264-6000

6051 U S Hwy 49
Comprehensive Radiology
Hattiesburg, MS 39401-7200
Phone (601) 288-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
24982MSMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franklin County Memorial Hospital CurrentSince Mar 17, 2024 Accepting new patients
Field Memorial Community Hospital CurrentSince Jun 9, 2024 Accepting new patients
Franklin County Memorial Hospital CurrentSince Mar 17, 2024 Accepting new patients
Franklin County Memorial Hospital CurrentSince Jul 1, 2025 Accepting new patients
Hattiesburg Clinic PA CurrentSince Jun 26, 2017 Accepting new patients
Field Memorial Community Hospital CurrentSince Oct 12, 2025 Accepting new patients
Field Memorial Community Hospital CurrentSince Jun 9, 2024 Accepting new patients
Field Memorial Community Hospital Family Medicine Current Accepting new patients
Hattiesburg Clinic, PA CurrentSince Jun 26, 2017 Accepting new patients
Comprehensive Radiology Services, PLLC Diagnostic Radiology CurrentSince Jun 20, 2017 Accepting new patients

Locations

136 Main St N
Bude, MS 39630
Phone (601) 384-2394

178 Highway 24 E
Centreville, MS 39631
Phone (601) 890-0500

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

5000 W 4th St
Hattiesburg, MS 39402
Phone (601) 264-2121

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

2630 Ridgewood Rd
Ste B
Jackson, MS 39216

40 Union Church Rd
Meadville, MS 39653
Phone (601) 384-2273

347 Magnolia Dr
Raleigh, MS 39153
Phone (601) 374-9070

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778025600000",
    "number": "1104117688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 W 4TH ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021000",
            "telephone_number": "800-494-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6051 U S HIGHWAY 49",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017200",
            "telephone_number": "800-494-8260",
            "fax_number": "859-368-0437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "178 Highway 24 E",
            "address_purpose": "LOCATION",
            "city": "Centreville",
            "state": "MS",
            "postal_code": "396314171",
            "country_code": "US",
            "telephone_number": "601-890-0500",
            "fax_number": "601-645-5873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "GERALD",
        "middle_name": "B",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-02",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KY",
            "license": "R2826",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "KY",
            "license": "R2826",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MS",
            "license": "24982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07124262",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.