Sandra D.M. Bruno, M.D., LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

020956 Issued in LA

Legal business name

SANDRA D.M. BRUNO, M.D., LLC

Doing business as

Moss Bluff Medical Clinic

Practice address

217 Sam Houston Jones Pkwy
Suite 101
Lake Charles, LA 70611-5603

Phone

(337) 217-1000

NPI assigned

Mar 13, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sandra D Bruno, MDNPI 1972533602

Title

Owner

Phone

(337) 217-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Moss Bluff Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sandra Denise Mary Bruno, M.D.

  • Internal Medicine Physician
  • Lake Charles, LA
  • NPI 1972533602
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295868024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 SAM HOUSTON JONES PKWY",
            "address_2": "SUITE 101",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706115603",
            "telephone_number": "337-217-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 SAM HOUSTON JONES PKWY",
            "address_2": "SUITE 101",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706115603",
            "telephone_number": "337-217-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDRA D.M. BRUNO, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRUNO",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-217-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "020956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1677027",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moss Bluff Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ricardo Samudia, MD
• Elicia Sanders
• Eric A Sanders, DDS
• Gwendolyn Sanders
• Jeremy Bernard Sanders, APRN, PMHNP-BC
• Holly Elizabeth Sann, LPN
• Rijo Santhosh, RPH
• Jamal Ghazi Saqer, MD
• Stacey Sargent
• Melanie King Sarro, LOTR

• Internal Medicine Physician in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.