NPIMap

Individual provider Active NPI

Brenda S Broussard, CNM

  • Advanced Practice Midwife
  • Baton Rouge, LA
National Provider Identifier
1982886180
Registry record updated Mar 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
AP01118 Issued in LA
Practice address
16777 Medical Center Dr
Baton Rouge, LA 70816-3254
Phone
(225) 754-3278
NPI assigned
Nov 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X R860596 MS
Advanced Practice Midwife 367A00000X AP01118 LA Primary
Advanced Practice Midwife 367A00000X RN091369 LA

Addresses

Primary practice location

16777 Medical Center Dr
Baton Rouge, LA 70816-3254

Mailing address

16777 Medical Center Dr
Baton Rouge, LA 70816-3254
Phone (225) 754-3278

Other identifiers 2

IdentifierTypeStateIssuer
04970861MedicaidMS
2125176MedicaidLA

Other names 1

  • Brenda K. Shantz Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
RN091369LAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300320000000",
    "number": "1982886180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16777 MEDICAL CENTER DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708163254",
            "telephone_number": "225-754-3278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16777 MEDICAL CENTER DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708163254",
            "telephone_number": "225-754-3278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "BRENDA",
        "middle_name": "S",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-29",
        "last_updated": "2011-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "MS",
            "license": "R860596",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "LA",
            "license": "AP01118",
            "primary": true
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "LA",
            "license": "RN091369",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04970861",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2125176",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRENDA",
            "last_name": "SHANTZ",
            "middle_name": "K.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.