Elzia Rena Broussard, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2022-00924 Issued in NC

Practice address

3000 Rogers Rd Ste 210
Wake Forest, NC 27587-5745

Phone

(919) 385-2120

Fax

(919) 385-2144

NPI assigned

Apr 9, 2019

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 NC

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 Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ebrousard253740@directhisp.wakemed.org
• Direct secure messaging: ebroussard426783@direct.medicine.duke.edu

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.

• Duke University Affiliated Physicians, Inc.

  • Internal Medicine Physician
  • Durham, NC
  • NPI 1316975972
  Medicare reassignment NPD
• Duke University Affiliated Physicians, Inc.

  • Family Medicine Physician
  • Durham, NC
  • NPI 1225073554
  NPD
• Duke University Affiliated Physicians, Inc.

  • Emergency Medicine Physician
  • Raleigh, NC
  • NPI 1710120795
  NPD

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1376006254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699",
            "telephone_number": "919-684-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 ROGERS RD STE 210",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875745",
            "telephone_number": "919-385-2120",
            "fax_number": "919-385-2144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "ELZIA",
        "middle_name": "RENA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-09",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2022-00924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridges and Beyond
• Angela Karen Bridges, M.S.W., L.C.S.W
• Eugene Drew Bridges, M.D.
• Lauren Bridges, LCSW
• Jasen E Brisson, MSPT
• Channette Tamekia Brown
• Elizabeth Brown, OTR/L
• Jennifer L Brown, MS, OTR/L
• Lauren Brown
• Tiffany Richardson Brown

• Pediatrics Physician in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; 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.