Thad Stephens Broussard, M.D.

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

014869 Issued in LA

Practice address

8037 Picardy Ave
Baton Rouge, LA 70809-3538

Phone

(225) 767-3680

Fax

(225) 767-5578

NPI assigned

Jul 12, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in LA

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

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205452800000",
    "number": "1396743506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8037 PICARDY AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093538",
            "telephone_number": "225-767-3680",
            "fax_number": "225-767-5578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8037 PICARDY AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093538",
            "telephone_number": "225-767-3680",
            "fax_number": "225-767-5578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "THAD",
        "middle_name": "STEPHENS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2008-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "LA",
            "license": "014869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1340901",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2695399",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "690092",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peggy Broussard, LPC
• Ranisa Washington Broussard
• Ryan Chase Broussard, PHARMD
• Shelby Broussard
• Taressa Anne Broussard, NP
• Yvette Hardy Broussard, RNFA
• Jessica Lynn Brousse, NP
• Margaret Elizabeth Browder, APRN
• Robert Dwight Brower, MD
• Reginald Browhow, LCSW

• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; 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.