NPIMap

Individual provider Active NPI

Cheryl Baker Broussard, APN

  • Family Nurse Practitioner
  • Las Vegas, NV
National Provider Identifier
1649581083
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN001231 Issued in NV
Practice address
1800 W. Charleston Blvd.
Las Vegas, NV 89102
Phone
(702) 224-7104
Fax
(702) 383-3685
NPI assigned
Jun 30, 2010
Last updated
Jun 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN001231 NV Primary

Addresses

Primary practice location

1800 W. Charleston Blvd.
Las Vegas, NV 89102

Mailing address

1800 W. Charleston Blvd.
Las Vegas, NV 89102
Phone (702) 383-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20111017000000 NV Practitioner - Nurse Practitioner 8123290244 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Las Vegas Medical Group LLCGroup PAC ID 6800118522, 51 clinicians

Practice addresses (Care Compare)

5380 S Rainbow Blvd
Suite 110
Las Vegas, NV 89118-1878
Phone (725) 333-8465

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN001231NVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Acv Nevada Bernstein PLLC CurrentSince Jul 1, 2021 Accepting new patients
Las Vegas Medical Group LLC Nurse Practitioner CurrentSince Jul 5, 2023 Accepting new patients
Adult Health and Wellness Center LLC PastSince Oct 13, 2024 Accepting new patients

Locations

1525 E Beltline Ave NE
Ste 101
Grand Rapids, MI 49525
Phone (616) 363-0055

1389 Galleria Dr
Ste 100
Henderson, NV 89014
Phone (725) 333-8400

4275 Burnham Ave
Ste 102
Las Vegas, NV 89119
Phone (702) 878-8346

5380 S Rainbow Blvd
Ste 110
Las Vegas, NV 89118
Phone (702) 382-6100

Interoperability endpoints

  • Direct secure messaging: cbroussard18771@direct.umcsn.com
  • FHIR API: https://fhir.meditouchehr.com/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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1277856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1649581083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 W. CHARLESTON BLVD.",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89102",
            "telephone_number": "702-383-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 W. CHARLESTON BLVD.",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89102",
            "telephone_number": "702-224-7104",
            "fax_number": "702-383-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "CHERYL",
        "middle_name": "BAKER",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-30",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "APN001231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.