NPIMap

Individual provider Active NPI

Yang-Tze Yoko Broussard, M.D.

  • Internal Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1922099662
Registry record updated Feb 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
022167 Issued in LA
Practice address
1722 Westwood St
Lake Charles, LA 70601-5743
Phone
(337) 439-2200
Fax
(337) 439-4484
NPI assigned
Nov 2, 2005
Last updated
Feb 3, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 022167 LA Primary
Pediatrics Physician 208000000X 022167 LA

Addresses

Primary practice location

1722 Westwood St
Lake Charles, LA 70601-5743

Mailing address

501 Doctor Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 433-8400

Other identifiers 1

IdentifierTypeStateIssuer
1483320MedicaidLA

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
I20090204000698 LA Practitioner - Pediatric MedicinePractitioner - Internal Medicine 5496819666 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imperial Health LLPGroup PAC ID 7719886779, 75 clinicians

Practice addresses (Care Compare)

277N Hwy 171
Suite 8
Lake Charles, LA 70611-5374
Phone (337) 312-0030

4201 Nelson Rd
Suite 100
Lake Charles, LA 70605-4117
Phone (337) 310-2273

501 Doctor Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 433-8400

711 Dr Michael Debakey Dr
Lake Charles, LA 70601-5785
Phone (337) 312-8528

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
022167LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Health, LLP Internal Medicine CurrentSince Nov 22, 2011 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Sep 1, 2015 Accepting new patients
Imperial Health LLP CurrentSince Nov 22, 2011 Accepting new patients
Christus Health Southwestern Louisiana Past Accepting new patients

Locations

1722 Westwood St
Lake Charles, LA 70601
Phone (337) 421-0090

4200 Nelson Rd
Lake Charles, LA 70605
Phone (318) 474-6370

501 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 312-8258

524 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 430-4455

711 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 312-8528

711 Dr Michael Debakey Dr
Ste 400
Lake Charles, LA 70601
Phone (337) 439-2200

1453 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 681-4138

Interoperability endpoints

  • Direct secure messaging: yoko.broussard@1288.direct.myezyaccess.com

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486080000000",
    "number": "1922099662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DOCTOR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "337-433-8400",
            "fax_number": "337-439-4484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 WESTWOOD ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015743",
            "telephone_number": "337-439-2200",
            "fax_number": "337-439-4484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "YANG-TZE",
        "middle_name": "YOKO",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2017-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "022167",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "022167",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1483320",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.