Organization Active NPI

Life Pulse Diagnostics LLC

  • General Practice Physician
  • Houston, TX
National Provider Identifier
1710626833
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
LIFE PULSE DIAGNOSTICS LLC
Doing business as
Life Pulse Diagnostics LLC
Practice address
6420 Richmond Ave Ste 405
Houston, TX 77057-6171
Phone
(713) 691-7744
Fax
(713) 691-6665
NPI assigned
May 27, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Gloria Broussard
Title
Owner
Phone
(713) 691-7744

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
EEG Specialist/TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 246ZE0500X
EEG TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 2472E0500X

Addresses

Primary practice location

6420 Richmond Ave Ste 405
Houston, TX 77057-6171

Mailing address

6420 Richmond Ave Ste 405
Houston, TX 77057-6171
Phone (713) 691-7744

Other names 1

  • Life Pulse Diagnostics LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230627000684 TX Part B Supplier - Clinic/Group Practice 1153793138 Receives reassigned benefits from 1 practitioner
Practice locations: Houston, TX

National Provider Directory

National Provider Directory

Locations

6420 Richmond Ave
Ste 405
Houston, TX 77057
Phone (713) 524-1915

13201 Northwest Fwy
Ste 425
Houston, TX 77040

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1710626833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6420 RICHMOND AVE STE 405",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770576171",
            "telephone_number": "713-691-7744",
            "fax_number": "713-691-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 RICHMOND AVE STE 405",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770576171",
            "telephone_number": "713-691-7744",
            "fax_number": "713-691-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE PULSE DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-27",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "713-691-7744"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246ZE0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other, EEG",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2472E0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Other, EEG",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Pulse Diagnostics LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Pulse Diagnostics LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.