Active NPI
Robert E Brouillard
- Specialist
- Boise, ID
National Provider Identifier
1154508703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT-2323
- Practice address
- 5440 W Franklin Rd
Ste 100
Boise, ID 83705-1079 - Phone
- (208) 422-1555
- NPI assigned
- Jan 25, 2008
- Last updated
- Sep 5, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT-2323 | ID | Primary |
Addresses
Primary practice location
5440 W Franklin Rd
Ste 100
Boise, ID 83705-1079
Mailing address
5440 W Franklin Rd
Ste 100
Boise, ID 83705-1079
Phone (208) 422-1555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-2323 | ID | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehabauthority, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Grand Forks, ND
- NPI 1730159690
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315180800000",
"number": "1154508703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5440 W FRANKLIN RD",
"address_2": "STE 100",
"city": "BOISE",
"state": "ID",
"postal_code": "837051079",
"telephone_number": "208-422-1555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5440 W FRANKLIN RD",
"address_2": "STE 100",
"city": "BOISE",
"state": "ID",
"postal_code": "837051079",
"telephone_number": "208-422-1555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUILLARD",
"first_name": "ROBERT",
"middle_name": "E",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-25",
"last_updated": "2011-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "ID",
"license": "PT-2323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.