John Broussard, DO

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

OS12241 Issued in FL

Practice address

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

Phone

(727) 258-7224

NPI assigned

Aug 27, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: john.broussard.1@27224.direct.athenahealth.com

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

• Regenerative Orthopedics and Sports Medicine, LLC

  • Orthopaedic Surgery Physician
  • MC Lean, VA
  • NPI 1275933533

  DC

  Medicare reassignment NPD
• Alliance Regenerative and Performance Medicine, PLLC

  • Sports Medicine (Family Medicine) Physician
  • St Petersburg, FL
  • NPI 1104418292
  NPD Authorized official
• Alliance Sports Rehab

  • Sports Physical Therapist
  • St Petersburg, FL
  • NPI 1033701123
  NPD
• Regenerative Orthopedics and Sports Medicine, LLC

  • Orthopaedic Surgery Physician
  • Washington, DC
  • NPI 1992458392
  NPD
• Fast Track Physical Therapy & Sports Performance

  • Physical Therapy Clinic/Center
  • Falls Church, VA
  • NPI 1679719421
  NPD (past)

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

{
    "created_epoch": "1282867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1174839161",
    "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": {
        "last_name": "BROUSSARD",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-27",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "FL",
            "license": "OS12241",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "VA",
            "license": "0102204383",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brookwood Florida, Inc
• Craig C Broome, DMD
• Kimberly Brossard, DC
• Mary C Brothers, ARNP
• Brian Paul Broussard, DPT
• Tammy D Brower
• Belynda Deatrice Brown-Nelson
• Anisthesia Brown
• Bonnie K Brown
• Brianna Brown

• Sports Medicine (Family Medicine) Physician in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Sports Medicine (Family Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.