NPIMap

Individual provider Active NPI

Michael Louis Broussard, M.D.

  • Hematology & Oncology Physician
  • Lake Charles, LA
National Provider Identifier
1699890376
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MD025609 Issued in LA
Practice address
2770 3Rd Ave Ste 210
Lake Charles, LA 70601-0404
Phone
(337) 494-6768
Fax
(337) 494-6792
NPI assigned
Mar 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X MD025609 LA Primary

Addresses

Primary practice location

2770 3Rd Ave Ste 210
Lake Charles, LA 70601-0404

Mailing address

PO Box 122579 Dept 2579
Dallas, TX 75312-2579
Phone (337) 494-2921

Other identifiers 1

IdentifierTypeStateIssuer
1043281MedicaidLA

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
I20080325000389 LA Practitioner - Medical Oncology 6406932946

Care Compare profile

Medicare Care Compare
Specialty
Medical Oncology
Education
Louisiana State University School of Medicine in New Orleans, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

PO Box
Dallas, TX 75312

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD025609LAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swlhs, Inc. Hematology & Oncology CurrentSince May 8, 2022 Accepting new patients

Locations

109 W 4th St
Deridder, LA 70634
Phone (337) 221-3004

2770 3rd Ave
#S350
Lake Charles, LA 70601
Phone (337) 494-6800

2770 3rd Ave
Ste 210
Lake Charles, LA 70601
Phone (337) 494-6768

619 S Huntington St
Sulphur, LA 70663
Phone (337) 494-3278

3924 Maplewood Dr
Sulphur, LA 70663
Phone (337) 494-6768

Organizations & group practices 1

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.

  • Swlhs, Inc.

    dba Medical Oncology Associates of SW La

    • Hematology & Oncology Physician
    • Lake Charles, LA
    • NPI 1164540175
    NPD

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1699890376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122579 DEPT 2579",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753122579",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 3RD AVE STE 210",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706010404",
            "telephone_number": "337-494-6768",
            "fax_number": "337-494-6792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "MICHAEL",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "LA",
            "license": "MD025609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043281",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.