Ian Matthew Broussard, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

LL41064 Issued in SC

Practice address

809 82ND Pkwy
Grand Strand Medical Center Gme Office
Myrtle Beach, SC 29572-4607

Phone

(843) 692-1752

Fax

(843) 692-1904

NPI assigned

Mar 21, 2017

Last updated

Jun 12, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC, LA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Emergency Medicine

Education

William Carey University College of Osteopathic Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Crowley Emergency Group LLCGroup PAC ID 1456572965, 26 clinicians

Ambassador Emergency Group, LLCGroup PAC ID 9537168901, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Acadia General Hospital Hospital, Crowley, LA, CCN 190044
• Ochsner Lafayette General Medical Center Hospital, Lafayette, LA, CCN 190002
• Ochsner University Hospital and Clinics Hospital, Lafayette, LA, CCN 190006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ian.broussard@hca5.eclinicaldirectplus.com
• Direct secure messaging: ibroussard396548@direct.ochsner.org
• Direct secure messaging: ibroussard51000@directmcleodehealth.org

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.

• Ambassador Emergency Group LLC

  • Emergency Medicine Physician
  • Lafayette, LA
  • NPI 1316030844
  Medicare reassignment Care Compare group NPD
• Crowley Emergency Group LLC

  • Emergency Medicine Physician
  • Crowley, LA
  • NPI 1508275538
  Medicare reassignment Care Compare group NPD
• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555
  Medicare reassignment NPD
• McLeod Health Cheraw

  dba McLeod Health Cheraw Physicians

  • Certified Registered Nurse Anesthetist
  • Cheraw, SC
  • NPI 1275912974

  Emergency Medicine

  Medicare reassignment NPD
• McLeod Loris Seacoast Hospital

  dba McLeod Loris/Seacoast Physicians

  • Certified Registered Nurse Anesthetist
  • Loris, SC
  • NPI 1265708119
  Medicare reassignment NPD
• Congress Emergency Group LLC

  • Emergency Medicine Physician
  • Lafayette, LA
  • NPI 1912316944
  Medicare reassignment NPD
• Parish State Emergency Physicians LLC

  • Emergency Medicine Physician
  • New Iberia, LA
  • NPI 1023832870
  Medicare reassignment NPD
• Riverside Emergency Physician Partners LLC

  • Emergency Medicine Physician
  • Lafayette, LA
  • NPI 1083107080
  Medicare reassignment NPD
• McLeod Health Cheraw

  dba McLeod Family Medicine - Darlington

  • Rural Health Clinic/Center
  • Darlington, SC
  • NPI 1003410903
  NPD
• McLeod Loris Seacoast Hospital

  dba McLeod Choice Pharmacy Seacoast

  • Community/Retail Pharmacy
  • Little River, SC
  • NPI 1629387352
  NPD

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

• Acadia General Hospital, Inc.

  dba Acadia General Hospital

  • General Acute Care Hospital
  • Crowley, LA
  • NPI 1669882940
  Care Compare affiliation
• Lafayette General Medical Center Inc

  • General Acute Care Hospital
  • Lafayette, LA
  • NPI 1275536799
  Care Compare affiliation
• University Hospital & Clinics, Inc.

  dba Ochsner University Hospital & Clinics

  • General Acute Care Hospital
  • Lafayette, LA
  • NPI 1306281126
  Care Compare affiliation

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497225600000",
    "number": "1871024968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 82ND PKWY",
            "address_2": "GRAND STRAND MEDICAL CENTER GME OFFICE",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724607",
            "telephone_number": "843-692-1752",
            "fax_number": "843-692-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 82ND PKWY",
            "address_2": "GRAND STRAND MEDICAL CENTER GME OFFICE",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724607",
            "telephone_number": "843-692-1752",
            "fax_number": "843-692-1904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "IAN",
        "middle_name": "MATTHEW",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-21",
        "last_updated": "2017-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "LL41064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Allen Brooks, O.D.
• Brookstone Nursing
• Ernest Broome Jr., PHARMACIST
• William Tyler Broome, COTA/L
• Justin Gerard Brothers, M.D.
• Dejuania Angela Brown-Rawls, D.O.
• Alexis Jo Brown, MD
• Brian L Brown, D.C.
• Caleb Ryan Brown, DO
• Cedric James Brown, LMSW

• Emergency Medicine Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Emergency Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.