NPIMap

Individual provider Active NPI

Kelly Eaton Boussert, M.D.

  • Interventional Pain Medicine Physician
  • Baton Rouge, LA
National Provider Identifier
1679717136
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
MD.207144 Issued in LA
Practice address
8080 Bluebonnet Blvd Ste 1000
Baton Rouge, LA 70810-7827
Phone
(225) 924-2424
Fax
(225) 408-7980
NPI assigned
Apr 28, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X MD.207144 LA
Interventional Pain Medicine Physician 208VP0014X MD.207144 LA Primary

Addresses

Primary practice location

8080 Bluebonnet Blvd Ste 1000
Baton Rouge, LA 70810-7827

Mailing address

8080 Bluebonnet Blvd Ste 1000
Baton Rouge, LA 70810-7827
Phone (225) 924-2424

Other identifiers 1

IdentifierTypeStateIssuer
1883450MedicaidLA

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
I20140908002288 LA Practitioner - Interventional Pain ManagementPractitioner - Anesthesiology 1658590583 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Anesthesiology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spine Center LLCGroup PAC ID 2769928746, 18 clinicians

Practice addresses (Care Compare)

9001 Summa Ave
Suite 346
Baton Rouge, LA 70809-3779
Phone (833) 774-6327

Hospital & facility affiliations

  • Womans Hospital Hospital, Baton Rouge, LA, CCN 190128
  • Baton Rouge General Medical Center Hospital, Baton Rouge, LA, CCN 190065
  • Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064
  • Baton Rouge Rehab Hospital Inpatient rehabilitation facility, Baton Rouge, LA, CCN 193028

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.207144LAMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baton Rouge Orthopaedic Clinic CurrentSince Jan 1, 2020 Accepting new patients
Advanced Pain Institute, LLC CurrentSince Mar 21, 2018 Accepting new patients
Spine Center, LLC CurrentSince Oct 16, 2025 Accepting new patients
Baton Rouge Orthopaedic Clinic, LLC Pain Medicine Current Accepting new patients

Locations

8080 Bluebonnet Blvd
Ste 1000
Baton Rouge, LA 70810
Phone (225) 408-6633

8585 Picardy Ave
Ste 518
Baton Rouge, LA 70809
Phone (225) 442-3166

9001 Summa Ave
Ste 346
Baton Rouge, LA 70809
Phone (225) 515-5700

42131 Veterans Ave
#100
Hammond, LA 70403

Organizations & group practices 4

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 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": "1240876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1679717136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 BLUEBONNET BLVD STE 1000",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708107827",
            "telephone_number": "225-924-2424",
            "fax_number": "225-408-7980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8080 BLUEBONNET BLVD STE 1000",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708107827",
            "telephone_number": "225-924-2424",
            "fax_number": "225-408-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSSERT",
        "first_name": "KELLY",
        "middle_name": "EATON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-28",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "LA",
            "license": "MD.207144",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "LA",
            "license": "MD.207144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1883450",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.