Active NPI
Monica Broussard, P.A. - C
- Physician Assistant
- Tulsa, OK
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2365
- Practice address
- 6465 S Yale Ave
Suite 420
Tulsa, OK 74136-7823 - Phone
- (918) 502-8810
- NPI assigned
- Mar 24, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2365 | OK | Primary |
Addresses
Primary practice location
6465 S Yale Ave
Suite 420
Tulsa, OK 74136-7823
Mailing address
6767 South Yale Avenue
Suite a
Tulsa, OK 74136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140630000536 | OK | Practitioner - Physician Assistant | 9133344427 | Reassigns benefits to 3 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
20 E 34TH St
Sand Springs, OK 74063-4001
Phone (918) 245-9675
8801 S 101St E Ave
Tulsa, OK 74133-5716
Phone (918) 294-4000
Hospital & facility affiliations
- Hillcrest Hospital South
- Bailey Medical Center, LLC
- Hillcrest Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ahs Oklahoma Physician Group LLC | Physician Assistant | Current | Accepting new patients |
Locations
20 E 34th St
Sand Springs, OK 74063
Phone (918) 245-9675
Dept 1206
Tulsa, OK 74182
9001 S 101st East Ave
Ste 280
Tulsa, OK 74133
Phone (918) 392-5411
8803 S 101st East Ave
Ste 300
Tulsa, OK 74133
Phone (918) 294-8844
Interoperability endpoints
- mbroussard133873@ahs.direct-ci.com
- https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Tulsa, OK
- NPI 1235182775
OK, Physician Assistant
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499299200000",
"number": "1376960799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6767 SOUTH YALE AVENUE",
"address_2": "SUITE A",
"city": "TULSA",
"state": "OK",
"postal_code": "74136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6465 S YALE AVE",
"address_2": "SUITE 420",
"city": "TULSA",
"state": "OK",
"postal_code": "741367823",
"telephone_number": "918-502-8810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "MONICA",
"credential": "P.A. - C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-24",
"last_updated": "2017-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "2365",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2017; 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.