NPIMap

Organization Active NPI

Synergy Care Southeast, LLC

Doing business as Synergy Care Southeast LLC - Texas

  • Physical Therapist
  • Lake Charles, LA
National Provider Identifier
1427466614
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SYNERGY CARE SOUTHEAST, LLC
Doing business as
Synergy Care Southeast LLC - Texas
Practice address
127 W Broad St
Lake Charles, LA 70601-4393
Phone
(337) 310-8500
Fax
(888) 241-3028
NPI assigned
Jul 31, 2014
Last updated
Oct 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Authorized official

Name
Todd R Broussard
Title
VP of Finance
Phone
(337) 310-8500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

127 W Broad St
Lake Charles, LA 70601-4393

Mailing address

127 W Broad St
Lake Charles, LA 70601-4393
Phone (337) 310-8500

Other names 1

  • Synergy Care Southeast LLC - Texas Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, FL, MN, AR, OK, IL, MO7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20141017000587 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6204079163 Receives reassigned benefits from 148 practitioners
Practice locations: Houston, TX; Tyler, TX; McKinney, TX; Fort Worth, TX; Dallas, TX; Conroe, TX; Boerne, TX
O20220930000976 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6204079163 Receives reassigned benefits from 3 practitioners
Practice locations: Cape Coral, FL
O20230621002846 MN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6204079163 Receives reassigned benefits from 4 practitioners
Practice locations: Eagan, MN; Hermantown, MN
O20230925002498 AR Part B Supplier - Clinic/Group Practice 6204079163 Receives reassigned benefits from 26 practitioners
Practice locations: Conway, AR; Heber Springs, AR; Maumelle, AR
O20230928001394 OK Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6204079163 Receives reassigned benefits from 28 practitioners
Practice locations: Edmond, OK
O20240731002829 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6204079163 Receives reassigned benefits from 19 practitioners
Practice locations: Peoria, IL; Savanna, IL
O20260423001582 MO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6204079163 Receives reassigned benefits from 24 practitioners
Practice locations: Saint Louis, MO

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

401 Southridge Pkwy
Heber Springs, AR 72543
Phone (501) 239-4685

127 W Broad St
Ste 850
Lake Charles, LA 70601
Phone (337) 310-8500

12399 Gravois Rd
Ste 100A
Saint Louis, MO 63127

18 Old San Antonio Rd
Boerne, TX 78006
Phone (386) 688-7988

Practitioners & affiliated clinicians

Practitioners 348

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 348

NPI Registry JSON

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1427466614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 W BROAD ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706014393",
            "telephone_number": "337-310-8500",
            "fax_number": "888-241-3028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 W BROAD ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706014393",
            "telephone_number": "337-310-8500",
            "fax_number": "888-241-3028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY CARE SOUTHEAST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "337-310-8500"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Synergy Care Southeast LLC - Texas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.