David Wayne Broussard, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA02959 Issued in TX

Practice address

717 N Business Ih 35 Ste 130
New Braunfels, TX 78130-7852

Phone

(830) 627-3311

Fax

(830) 627-3312

NPI assigned

Oct 27, 2005

Last updated

Sep 14, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeast Emergency Physician Associates, P.a.

  • Emergency Medicine Physician
  • Beaumont, TX
  • NPI 1235155102
  NPD (past)
• Southwest Texas Two Medical Group, PLLC

  • Primary Care Clinic/Center
  • Houston, TX
  • NPI 1659950475
  NPD (past)
• Synergenx Physician Services PLLC

  • Primary Care Clinic/Center
  • Houston, TX
  • NPI 1720512429
  NPD (past)

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1487644654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 N BUSINESS IH 35 STE 130",
            "city": "NEW BRAUNFELS",
            "state": "TX",
            "postal_code": "781307852",
            "telephone_number": "830-627-3311",
            "fax_number": "830-627-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 N BUSINESS IH 35 STE 130",
            "city": "NEW BRAUNFELS",
            "state": "TX",
            "postal_code": "781307852",
            "telephone_number": "830-627-3311",
            "fax_number": "830-627-3312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "DAVID",
        "middle_name": "WAYNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Hilaire Brodtmann, O.D.
• Gregory Jon Brogden, ACNP-BC
• Brookdale Senior Living Communities, Inc. (Brookdale New Braunfels)
• Bailey Hunter Brooke, CCC-SLP
• Dorothy Marie Brooker, LMFT
• Angela Michelle Brown, LCSW
• Caitlin Brown, PTA
• Danielle Brown, MD
• Matthew Ronald Brown
• Stephanie E Brown, DDS

• Physician Assistant in New Braunfels, TX
• Providers in New Braunfels, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; 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.