COURTNEY J BROUSSARD (CRNA) – Certified Registered Nurse Anesthetist, NPI 1720389141

COURTNEY J BROUSSARD (CRNA) is a healthcare provider. based in Salem, Illinois. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials CRNA. They hold a License No. RN108581 (LA). The NPI Number for COURTNEY J BROUSSARD (CRNA) is 1720389141

Main info

Male
16 Years Of Experience
Accepts Medicare Assignment
Name
COURTNEY J BROUSSARD (CRNA)
NPI
1720389141
Phone
(618) 548-3194
Address
1201 Ricker Rd
Enumeration Date
17 November 2010
Last Update Date
30 September 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6184368000
Graduation Year
2010 (16 years ago)
PAC ID
5496936072
Group Practice PAC ID
6709788920
Professional Enrollment ID
I20120517000139
Address ID
IL628013056CE400XXAVEX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:15State licenses:1Digital endpointsOther names

2,265 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in IL

Provider Addresses for COURTNEY J BROUSSARD (CRNA)

  • 1201 Ricker Rd

    Salem, IL 628814263

    Phone: (618) 548-3194

    Fax: (618) 740-0122

    Type: Location

  • 255 W MICHIGAN AVE

    JACKSON, MI 492012218

    Phone: (800) 242-1131

    Fax: (517) 787-7379

    Type: Mailing

  • 4200 HOUMA BLVD

    METAIRIE, LA 700062970

    Phone: (504) 779-5515

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2012-05-17

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20120517000139ICertified Registered Nurse Anesthetist (Crna)ILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
00811Anesthesia for other procedure on large bowel using an endoscope2222$0
00142Anesthesia for lens surgery1616$0
01810Anesthesia for procedure on nerves, muscles, tendons, and tissue of forearm, wrist, and hand1615$0
00812Anesthesia for exam of colon using an endoscope1515$0
00731Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope1313$0
View full utilization report →

Insurance plans in this area (ZIP 62881)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6709788920View full group profile
NameSpecialtyState
Cardiovascular Disease (Cardiology), Internal MedicineIL
Diagnostic RadiologyFL
Certified Registered Nurse Anesthetist (Crna)IL
Diagnostic RadiologyPA
Cardiac Electrophysiology, Cardiovascular Disease (Cardiology)MO
-IN
-IL
A N E S T H E S I O L O G YIL
Mental Health CounselorIL
Internal MedicineIL

Reviews

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Frequently asked questions

Is COURTNEY J BROUSSARD (CRNA) listed with a National Provider Identifier?
Yes — COURTNEY J BROUSSARD (CRNA) has NPI 1720389141 on file in the registry.
Is COURTNEY J BROUSSARD (CRNA) still an active registrant?
COURTNEY J BROUSSARD (CRNA) carries an active NPI according to the public dataset.
How would a patient describe COURTNEY J BROUSSARD (CRNA)'s focus?
For COURTNEY J BROUSSARD (CRNA), the primary taxonomy reads as Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
What practice footprint exists for COURTNEY J BROUSSARD (CRNA)?
Travel planning: use Salem, Illinois as the reference point for COURTNEY J BROUSSARD (CRNA), then confirm.
When was this NPI issued?
Enumeration for COURTNEY J BROUSSARD (CRNA) is noted as November 17, 2010 where the registry provides it.

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