NPIMap

Organization Active NPI

Broussard Family Practice, PLLC

  • Specialist
  • Beaumont, TX
National Provider Identifier
1710320908
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
L2891 Issued in TX
Legal business name
BROUSSARD FAMILY PRACTICE, PLLC
Practice address
810 Hospital Dr Ste 100
Beaumont, TX 77701-4633
Phone
(409) 833-0342
NPI assigned
Apr 8, 2013
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Juliette Rose Broussard, FNPCNPI 1871713073
Title
Family Nurse Practitioner/Owner
Phone
(409) 833-0342

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X L2891 TX Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 651610 TX

Addresses

Primary practice location

810 Hospital Dr Ste 100
Beaumont, TX 77701-4633

Mailing address

PO Box 7096
Beaumont, TX 77726-7096
Phone (409) 833-0342

Other practice location 1

7675 Folsom Dr Ste 300B
Beaumont, TX 77706-7299
Phone (409) 833-0342

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130730000074 TX Part B Supplier - Clinic/Group Practice 4385885672 Receives reassigned benefits from 4 practitioners
Practice locations: Beaumont, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2066878Broussard Family Practice, PLLC7675 Folsom Drive Ste 300B, Beaumont, TX 77706Certificate of waiverOct 3, 2027

National Provider Directory

National Provider Directory

Locations

7675 Folsom Dr
Ste 300B
Beaumont, TX 77706
Phone (409) 833-0342

810 Hospital Dr
Ste 100
Beaumont, TX 77701
Phone (409) 212-5933

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1710320908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7096",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777267096",
            "telephone_number": "409-833-0342",
            "fax_number": "877-770-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 HOSPITAL DR STE 100",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014633",
            "telephone_number": "409-833-0342"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7675 Folsom Dr Ste 300B",
            "address_purpose": "LOCATION",
            "city": "Beaumont",
            "state": "TX",
            "postal_code": "777067299",
            "country_code": "US",
            "telephone_number": "409-833-0342",
            "fax_number": "877-770-4091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BROUSSARD FAMILY PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "JULIETTE",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "409-833-0342",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNPC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "L2891",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "651610",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.