Shana Marie Broussard

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

903748 Issued in MS

Practice address

10404 Tucker Rd # LLC
Vancleave, MS 39565-7922

Phone

(228) 354-9505

NPI assigned

May 5, 2020

Last updated

Jun 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ocean Springs Urgent CareGroup PAC ID 0244426195, 18 clinicians

Coastal Family Health Center, IncGroup PAC ID 8628989654, 48 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sbroussard@direct.mhg.com
• Direct secure messaging: shana.broussard.p1@direct.cfhc.nextgenshare.com

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.

• Coastal Family Health Center, Inc

  dba Coastal Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Biloxi, MS
  • NPI 1629066782
  Medicare reassignment Care Compare group NPD
• Ocean Springs Urgent Care

  • Urgent Care Clinic/Center
  • Ocean Springs, MS
  • NPI 1871808022
  Medicare reassignment Care Compare group NPD
• Maxem Health Urgent Care Diberville

  • Urgent Care Clinic/Center
  • D'Iberville, MS
  • NPI 1265991608
  Medicare reassignment NPD
• Orange Grove Urgent Care

  • Urgent Care Clinic/Center
  • Gulfport, MS
  • NPI 1831330661
  Medicare reassignment NPD
• Pascagoula Urgent Care

  • Urgent Care Clinic/Center
  • Pascagoula, MS
  • NPI 1235442872
  Medicare reassignment NPD
• Coastal Family Health Center, Inc

  dba Coastal Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Vancleave, MS
  • NPI 1104814359
  NPD
• Coastal Family Health Center, Inc

  dba Coastal Family Health Center, Inc Central Elementary

  • Federally Qualified Health Center (FQHC)
  • Lucedale, MS
  • NPI 1427842913
  NPD
• Gulfport 49 Imaging, LLC

  • Radiology Clinic/Center
  • Gulfport, MS
  • NPI 1134702301
  NPD
• Cavalier County Memorial Hospital Association

  dba Cavalier County Memorial Hospital & Clinics

  • Critical Access Hospital
  • Langdon, ND
  • NPI 1750328662
  NPD (past)

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

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1134740798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4511 LYNN DR",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395329477",
            "telephone_number": "228-860-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10404 TUCKER RD # LLC",
            "city": "VANCLEAVE",
            "state": "MS",
            "postal_code": "395657922",
            "telephone_number": "228-354-9505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "SHANA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-05",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "903748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bienville Orthopaedic Specialists, LLC
• Bienville Surgery Center, LLC
• Bienville Therapy, LLC
• Lennon E. Bowen IV, M.D.
• Elizabeth Louise Boyle, MS, LPC
• Sarah Burke
• Christopher Burks, MD
• Burnham Drugs No. 4 LLC
• Burnham-McKinney Pharmacy No 4 LLC
• Karen Veronica Carlisle-Bond, FNP-C

• Family Nurse Practitioner in Vancleave, MS
• Providers in Vancleave, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.