John Broussard, DO
John Broussard, DO is a Sports Medicine (Family Medicine) Physician in St Petersburg, FL, registered under NPI 1174839161. NPPES records them as a sole proprietor, meaning the practice is not incorporated as a separate legal entity.
Getting there
The practice address on file is 111 2ND AVE NE STE 1401, St Petersburg, FL 33701. We have not yet mapped what surrounds this office — parking, transit, and nearby pharmacies are added as our data collection reaches each location.
Credentials and Medicare
| Licence | State | Specialty |
|---|---|---|
| OS12241 | FL | Sports Medicine (Family Medicine)… primary |
| 0102204383 | VA | Sports Medicine (Family Medicine)… |
Licences are recorded in 2 states: FL, VA. Providers licensed in several states often practise near a state border or deliver telehealth across state lines.
- Status
- Approved
- Provider type
- Practitioner - Sports Medicine
- PAC ID
- 2567605553
Medicare enrolment is recorded as approved under the provider type Practitioner - Sports Medicine. This means the provider is enrolled to bill Medicare, though it does not tell you whether they are currently accepting new Medicare patients. Call the office to confirm.
Licensed in 2 states
This provider holds licences in 2 states: Florida and Virginia. The practice address on file is in St Petersburg, FL, but a licence in another state usually means they see patients there too — either at a second location or by telehealth. If the address above is far from you, it is worth calling to ask whether they practise closer to where you live.
- Licence
- OS12241
- Specialty
- Sports Medicine (Family Medicine)…
- Licence
- 0102204383
- Specialty
- Sports Medicine (Family Medicine)…
Licence numbers are self-reported to NPPES at registration. They do not confirm a licence is currently active, in good standing, or valid for the specialty shown — only the state board can tell you that, which is why we link to each one.
What Sports Medicine covers
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. NUCC Health Care Provider Taxonomy, code 207QS0010X
All registered taxonomy codes
This provider registers 2 taxonomy codes. The primary code is what appears on most claims; the others record additional recognised specialties.
| Code | Specialty | Licence | State | |
|---|---|---|---|---|
| 207QS0010X | Sports Medicine (Family Medicine) Physician Sports Medicine | OS12241 | FL | primary |
| 207QS0010X | Sports Medicine (Family Medicine) Physician Sports Medicine | 0102204383 | VA |
The taxonomy records how the provider classifies their own practice. It does not confirm which conditions they currently treat, whether they are accepting new patients, or which insurance they take — call the office for that.
Full NPPES record
An NPI-1 identifies a single person. It stays with the clinician for life, even if they move practice or change state, which is why the address on file can lag behind where they actually work today.
| NPI | 1174839161 valid check digit |
|---|---|
| Entity type | Individual (NPI-1) |
| Enumeration date | Aug 27, 2010 |
| Last updated | Aug 27, 2020 |
| Status | Active |
| Sole proprietor | Yes |
| Credential | DO |
| Practice address |
111 2ND AVE NE STE 1401 St Petersburg, FL 33701 (727) 258-7224 |
Number check
How the check works, step by step
Every NPI carries a Luhn check digit — the same scheme used on credit cards. CMS prefixes the number with 80840 before computing it, which marks it as a US health identifier.
| Digit | 8 | 0 | 8 | 4 | 0 | 1 | 1 | 7 | 4 | 8 | 3 | 9 | 1 | 6 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doubled? | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 |
| Value | 8 | 0 | 8 | 8 | 0 | 2 | 1 | 5 | 4 | 7 | 3 | 9 | 1 | 3 |
Sum = 59 · next multiple of 10 = 60 · check digit = 1 · actual last digit = 1
A valid check digit only means the number is well-formed. It does not mean the provider is licensed, active, or in good standing — those are separate questions answered by the sections above.