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DR. JOHN BROUSSARD DO
NPI 1174839161
Family Medicine - Sports Medicine in St Petersburg, FL

Active since August 27, 2010PECOS Enrolled
111 2ND AVE NE STE 1401, ST PETERSBURG, FL 33701(727) 258-7224 Get Directions Write a Review

NPPES record last updated: August 27, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 27, 2020, Mar 21, 2016 (2 updates tracked since 2016).

About Dr. John Broussard Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JOHN BROUSSARD DO (NPI 1174839161) is an individual sports medicine provider in St Petersburg, Florida, licensed in Florida (OS12241) and active in the NPI registry since August 2010. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174839161
Entity TypeIndividualMale
Primary Taxonomy207QS0010X
Provider Legal NameDR. JOHN BROUSSARDCredential: DO
Location Address111 2ND AVE NE STE 1401St Petersburg, FL 33701-3480
Mailing Address111 2nd Ave Ne Ste 1401St Petersburg, FL 33701-3480 · (727) 258-7224
Phone(727) 258-7224
Sole ProprietorYes
Enumeration DateAugust 27, 2010
Last NPPES UpdateAugust 27, 20202 updates tracked since enumeration
NPPES CertifiedAugust 27, 2020
✔ NPI 1174839161 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
Licenses✔ Licensed in FL · OS12241✔ Licensed in VA · 0102204383
Definition
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
111 2ND AVE NE STE 1401, St Petersburg, FL 33701
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. John Broussard Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show John Broussard reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Regenerative Orthopedics And Sports Medicine, LLC
829 mi
Orthopaedic Surgery
1760 OLD MEADOW RD STE 220
Mc Lean, VA 22102
  • Reassigned Medicare billing, District of Columbia enrollment
  • 9 clinicians in this Medicare group
NPI 1275933533 (703) 783-3529

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33701 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.62 typical visit price
range $56.00 – $171.84
Typical copayment $21.90 (range $14.00 – $42.96)
Most-billed visit code 99203
Established Patient
$99.16 typical visit price
range $17.57 – $139.16
Typical copayment $24.79 (range $4.39 – $34.79)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALLIANCE SPORTS REHAB
Physical Therapist (Sports)
111 2ND AVE NE STE 1401
ST PETERSBURG, FL 33701
Pinellas County (727) 258-7224
ALLIANCE REGENERATIVE AND PERFORMANCE MEDICINE, PLLC
Family Medicine (Sports Medicine)
111 2ND AVE NE STE 1401
ST PETERSBURG, FL 33701
Pinellas County (727) 258-7224
ALEXANDER EBINGER
Physical Therapist (Sports)
111 2ND AVE NE STE 1401
ST PETERSBURG, FL 33701
Pinellas County (727) 258-7224
DR. DENNIS COLON DPT
Physical Therapist
111 2ND AVE NE STE 1401
ST PETERSBURG, FL 33701
Pinellas County (727) 258-7224
BRIAN PAUL BROUSSARD DPT
Physical Therapist (Sports)
111 2ND AVE NE STE 1401
ST PETERSBURG, FL 33701
Pinellas County (727) 258-7224

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is John Broussard's NPI number?

The NPI number for John Broussard is 1174839161. It was assigned to this individual provider in the NPPES registry on August 27, 2010.

Where is John Broussard located?

John Broussard practices at 111 2nd Ave NE Ste 1401, St Petersburg, FL 33701. The listed phone number is (727) 258-7224.

What is John Broussard's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Is John Broussard enrolled in Medicare?

Yes. John Broussard is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for John Broussard's services?

According to the CMS Revalidation Reassignment List (October 2026 release), John Broussard reassigns Medicare benefits to Regenerative Orthopedics And Sports Medicine, LLC (Mc Lean, VA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for John Broussard's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for John Broussard was last updated on August 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.