DR. ANDRE EDMOND BROUSSARD M.D.
NPI 1710069695
Pediatrics - Sports Medicine in New York, NY

Q: What is Andre Broussard's NPI number?

The NPI number for Andre Broussard is 1710069695. It was assigned to this individual provider in the NPPES registry on October 19, 2006.

Q: What is Andre Broussard's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Sports Medicine, with taxonomy code 2080S0010X.

Q: When was this NPI record last updated?

The NPPES record for Andre Broussard was last updated on November 29, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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 October 19, 2006PECOS Enrolled

1901 FIRST AVE, 523, NEW YORK, NY 10029(212) 423-6228(212) 534-7831 Get Directions Write a Review

NPPES record last updated: November 29, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Dr. Andre Edmond Broussard M.d. NPPES

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

DR. ANDRE EDMOND BROUSSARD M.D. (NPI 1710069695) is an individual sports medicine provider in New York, New York, licensed in New York (MD126425) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1710069695

Entity TypeIndividualMale

Primary Taxonomy2080S0010X

Provider Legal NameDR. ANDRE EDMOND BROUSSARDCredential: M.D.

Location Address1901 FIRST AVE, 523New York, NY 10029

Mailing Address1901 1st Ave, Room 523New York, NY 10029-7404 · (212) 423-6228 · Fax (212) 423-7697

Phone(212) 423-6228

Fax(212) 534-7831

Sole ProprietorYes

Enumeration DateOctober 19, 2006

Last NPPES UpdateNovember 29, 2007

✔ NPI 1710069695 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080S0010X

License✔ Licensed in NY · MD126425

Definition

A pediatrician who is 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 healthcare of the individual engaged in physical exercise (sports) whether as an individual or in team participation.

1901 FIRST AVE, New York, NY 10029

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Other Identifiers 1

Medicare UPINC07074NY

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Andre Edmond Broussard M.d. 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 Andre Broussard reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Metropolitan Medical Practice Plan PC

Same address

General Practice

1901 1ST AVE
New York, NY 10029

Reassigned Medicare billing, New York enrollment
623 clinicians in this Medicare group

NPI 1306138383 (212) 423-7337

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

Other Providers at the Same Location NPPES 8

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

DR. MAHRUKH D BAMJI M.D.

Pediatrics

1901 FIRST AVE, METROPOLITAN HOSPITAL CENTER
NEW YORK, NY 10029

New York County (212) 423-6841

MOHAMAD AL-RASHDAN M.D

Psychiatry & Neurology (Psychiatry)

1901 FIRST AVE, METROPOLITAN HOSPITAL CENTER
NEW YORK, NY 10029

New York County (212) 423-6262

MS. RHINA ANABEL PENA

Social Worker

1901 FIRST AVE
NEW YORK, NY 10029

New York County (212) 423-8559

MS. ROSEMARY MILIAN LPN

Licensed Practical Nurse

1901 FIRST AVE
NYC, NY 10029

New York County (212) 423-8175

SOFIYA KOGAN RPH

Pharmacist

1901 FIRST AVE, METROPOLITAN HOSPITAL CENTER
NEW YORK, NY 10029

New York County (212) 423-6609

MR. GEORGE MORALES LMSW

Social Worker

1901 FIRST AVE, METROPOLITAN HOSPITAL
NEW YORK, NY 10029

New York County (212) 423-7385

KATHLEEN MCALLISTER P.A.

Physician Assistant

1901 FIRST AVE, 1215A
NEW YORK, NY 10029

New York County (212) 423-6801

DR. ANDREA JNO CHARLES

Physical Medicine & Rehabilitation

1901 FIRST AVE
NY, NY 10029

New York County (212) 423-6200

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 Andre Broussard's NPI number?

The NPI number for Andre Broussard is 1710069695. It was assigned to this individual provider in the NPPES registry on October 19, 2006.

Where is Andre Broussard located?

Andre Broussard practices at 1901 First Ave 523, New York, NY 10029. The listed phone number is (212) 423-6228.

What is Andre Broussard's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Sports Medicine, with taxonomy code 2080S0010X.

Is Andre Broussard enrolled in Medicare?

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

Which organization bills Medicare for Andre Broussard's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Andre Broussard reassigns Medicare benefits to Metropolitan Medical Practice Plan PC (New York, NY). 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 Andre 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 Andre Broussard was last updated on November 29, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.