NPIMap

Organization Active NPI

Alliance Regenerative and Performance Medicine, PLLC

  • Sports Medicine (Family Medicine) Physician
  • St Petersburg, FL
National Provider Identifier
1104418292
Registry record updated Feb 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
ALLIANCE REGENERATIVE AND PERFORMANCE MEDICINE, PLLC
Practice address
111 2ND Ave NE Ste 1401
St Petersburg, FL 33701-3480
Phone
(727) 258-7224
NPI assigned
Feb 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2021

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

Authorized official

Name
Dr. John Broussard, DONPI 1174839161
Title
Owner
Phone
(727) 258-7224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QS0010X Primary

Addresses

Primary practice location

111 2ND Ave NE Ste 1401
St Petersburg, FL 33701-3480

Mailing address

111 2ND Ave NE Ste 1401
St Petersburg, FL 33701-3480
Phone (727) 258-7224

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612828800000",
    "number": "1104418292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 2ND AVE NE STE 1401",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013480",
            "telephone_number": "727-258-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 2ND AVE NE STE 1401",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013480",
            "telephone_number": "727-258-7224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE REGENERATIVE AND PERFORMANCE MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-258-7224",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.