Jason Broussard, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

DO.000136 Issued in LA

Practice address

1111 Line Ave FL 3
Shreveport, LA 71101-3841

Phone

(318) 716-4610

Fax

(318) 716-4690

NPI assigned

May 31, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in LA, MS, TX3 enrollments

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 3

Specialty

Psychiatry

Education

Kansas City University of Med & Biosciences, College of Osteo Med, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Access Serenity of Louisiana LLC 13 clinicians

WK Center for Psychiatric Support 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111
• Beacham Memorial Hospital Hospital, Magnolia, MS, CCN 250049

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: minjbrous@yourcarecommunity.org
• Direct secure messaging: jason.broussard.2@27785.direct.athenahealth.com
• Direct secure messaging: jbroussard@direct.wkhs.com
• Direct secure messaging: jason.broussard.1@5868.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.

• WK Center for Psychiatric Support

  • Psychiatry Physician
  • Shreveport, LA
  • NPI 1609194356

  LA, Psychiatry

  Medicare reassignment Care Compare group NPD
• Access Serenity of Louisiana, LLC

  • Psychiatry Physician
  • Many, LA
  • NPI 1104378629

  LA, TX

  Medicare reassignment Care Compare group
• Access Serenity of Mississippi LLC

  • Psychiatry Physician
  • Many, LA
  • NPI 1801349238

  MS, Psychiatry

  Medicare reassignment NPD
• Allegiance Behavioral Health Center of Plainview, LLC

  • Psychiatric Hospital
  • Plainview, TX
  • NPI 1386691046
  NPD
• Allegiance Health Center of Ruston LLC

  • Psychiatric Hospital
  • Monroe, LA
  • NPI 1407207863
  NPD (past)
• CLHG - Minden, LLC

  • Psychiatric Hospital Unit
  • Minden, LA
  • NPI 1740350560
  NPD (past)
• CLHG-Ville Platte LLC

  • Psychiatric Hospital Unit
  • Ville Platte, LA
  • NPI 1063185502
  NPD (past)
• Willis Knighton Medical Center, Inc.

  • Psychiatric Hospital Unit
  • Shreveport, LA
  • NPI 1912059932
  NPD (past)
• Freedom Hospital of Magnolia, LLC

  • Rural Acute Care Hospital
  • Magnolia, MS
  • NPI 1871953802
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Bossier City, LA
  • NPI 1003968579

  Hospital

  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1124170691

  Hospital

  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1275685539

  Hospital

  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572

  Hospital

  Care Compare affiliation
• Freedom Hospital of Magnolia, LLC

  • Rural Acute Care Hospital
  • Magnolia, MS
  • NPI 1871953802

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1376744771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 LINE AVE FL 3",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013841",
            "telephone_number": "318-716-4610",
            "fax_number": "318-716-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 LINE AVE FL 3",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013841",
            "telephone_number": "318-716-4610",
            "fax_number": "318-716-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "JASON",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-31",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "DO.000136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1079243",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bruce P. Brouillette, MD
• Rose Marie Brouillette, M.D.
• Andre Paul Broussard, MD
• Brittany Jean Broussard, CIT
• Daryn Broussard, LPC
• Marlene Marie Broussard, M.D.
• Philip Brandon Broussard I, CIT
• Sherry Broussard, MA
• Misty Brower
• Sherita Prelow Brown-Mims, LPC

• All providers in Shreveport, LA
• Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; 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.