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

Q: 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.

Q: What is John Broussard's specialty?

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

Q: 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 5 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.

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: August 09, 2026.

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

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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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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

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)