NPIMap

Individual provider Active NPI

Robert Craig Broussard, MD

  • Pulmonary Disease Physician
  • Lake Charles, LA
National Provider Identifier
1821007170
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
018460 Issued in LA
Practice address
2770 3Rd Ave Ste 350
Lake Charles, LA 70601-0404
Phone
(337) 494-2750
Fax
(337) 494-2760
NPI assigned
Aug 5, 2006
Last updated
Jun 9, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 018460 LA Primary

Addresses

Primary practice location

2770 3Rd Ave Ste 350
Lake Charles, LA 70601-0404

Mailing address

PO Box 122309
Dept 2309
Dallas, TX 75312-2309
Phone (337) 494-2921

Other identifiers 2

IdentifierTypeStateIssuer
1396826MedicaidLA
5J895DR91OtherLAMEDICARE

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
I20101108000302 LA Practitioner - Pulmonary Disease 2567657331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Louisiana State University School of Medicine in Shreveport, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
LCMS Pulmonary Associates of Southwest LouisianaGroup PAC ID 0446439939, 9 clinicians

Practice addresses (Care Compare)

2770 3Rd Ave
Suite 350
Lake Charles, LA 70601-0404
Phone (337) 494-2750

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
018460LAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
LCMS Pulmonary Associates of Southwest Louisiana Pulmonary Disease CurrentSince Nov 1, 2010 Accepting new patients
Lake Charles Medical Services, Inc Internal Medicine PastSince Jun 12, 2022 Accepting new patients
Radiology Associates of Southwest Louisiana Past Accepting new patients
Imperial Health LLP Past Accepting new patients

Locations

1701 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-3000

2770 3rd Ave
Lake Charles, LA 70601
Phone (337) 494-2674

2770 3rd Ave
Ste 110
Lake Charles, LA 70601
Phone (337) 494-2750

2770 3rd Ave
Ste 350
Lake Charles, LA 70601
Phone (337) 494-2750

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, 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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1821007170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122309",
            "address_2": "DEPT 2309",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753122309",
            "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 350",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706010404",
            "telephone_number": "337-494-2750",
            "fax_number": "337-494-2760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "ROBERT",
        "middle_name": "CRAIG",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "LA",
            "license": "018460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396826",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "5J895DR91",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.