NPIMap

Individual provider Active NPI

Andre Paul Broussard, MD

  • Urology Physician
  • Shreveport, LA
National Provider Identifier
1407147291
Registry record updated May 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
300911 Issued in LA
Practice address
1501 Kings Hwy
Shreveport, LA 71103-4228
Phone
(318) 675-5053
NPI assigned
Apr 27, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 300911 LA Primary

Addresses

Primary practice location

1501 Kings Hwy
Shreveport, LA 71103-4228

Mailing address

120 Rue Louis Xiv
Lafayette, LA 70508-5739
Phone (337) 769-7779

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160616001354 LA Practitioner - Urology 8921303942 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Louisiana State University School of Medicine in Shreveport, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Urology LLCGroup PAC ID 5597833772, 27 clinicians

Practice addresses (Care Compare)

120 Rue Louis Xiv
Lafayette, LA 70508-5739
Phone (337) 600-1678

1926 S Union St
Opelousas, LA 70570-5725
Phone (337) 594-4025

2308 E Main St
Suite a
New Iberia, LA 70560-4029
Phone (337) 408-8676

Hospital & facility affiliations

  • Nursing Specialties Home health agency, Lafayette, LA, CCN 197297
  • Iberia Medical Center Hospital, New Iberia, LA, CCN 190054
  • Our Lady of Lourdes Regional Medical Center, Inc Hospital, Lafayette, LA, CCN 190102
  • Park Place Surgical Hospital Hospital, Lafayette, LA, CCN 190255
  • Ochsner Lafayette General Medical Center Hospital, Lafayette, LA, CCN 190002
  • Bayou Bend Health System Hospital, Franklin, LA, CCN 191310

Merit-based Incentive Payment System (MIPS)

Final score
93.2 of 100Reported as group
Promoting interoperability
92
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Urology, LLC Urology CurrentSince Jul 18, 2016 Accepting new patients
Lsuhn Billing LLC CurrentSince Nov 13, 2018 Accepting new patients
Lsuhn Billing LLC CurrentSince Nov 13, 2018 Accepting new patients
Southern Urology LLC Urology CurrentSince Jul 18, 2016 Accepting new patients
Iberia Medical Center Physician Practice Network Past Accepting new patients

Locations

2390 W Congress St
Lafayette, LA 70506
Phone (337) 261-6000

120 Rue Louis Xiv
Bldg 2
Lafayette, LA 70508
Phone (337) 233-6665

120 Rue Louis Xiv
Lafayette, LA 70508
Phone (337) 233-6665

2308 E Main St
Ste D
New Iberia, LA 70560
Phone (337) 374-7242

2309 E Main St
Ste 300
New Iberia, LA 70560
Phone (337) 560-1801

2308 E Main St
Ste A
New Iberia, LA 70560
Phone (337) 364-8566

Interoperability endpoints

  • Direct secure messaging: andrebroussard@southernuro.medalliesdirect.net
  • Direct secure messaging: abroussard1443371@direct.ochsner.org
  • FHIR API: https://fhir-usa.unify.chbase.com/org/ibermed-05842f36

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1303862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464048000000",
    "number": "1407147291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 RUE LOUIS XIV",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085739",
            "telephone_number": "337-769-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "ANDRE",
        "middle_name": "PAUL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-27",
        "last_updated": "2016-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "LA",
            "license": "300911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.