NPIMap

Individual provider Active NPI

Kevin Boubouleix, MD

  • Emergency Medicine Physician
  • Evanston, IL
National Provider Identifier
1013578475
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036161095 Issued in IL
Practice address
2650 Ridge Ave
Emergency Medicine
Evanston, IL 60201-1700
Phone
(847) 570-2114
NPI assigned
Jun 26, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036161095 IL Primary

Addresses

Primary practice location

2650 Ridge Ave
Emergency Medicine
Evanston, IL 60201-1700

Mailing address

2650 Ridge Ave Ste 1223
Evanston, IL 60201-1700
Phone (847) 570-2040

Other practice location 1

1969 W Ogden Ave
Chicago, IL 60612-3765
Phone (312) 864-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221114000754 IN Practitioner - Emergency Medicine 7012384571 Reassigns benefits to 2 organizations
I20230703002956 IL Practitioner - Emergency Medicine 7012384571 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
R Franklin University of Med & Sci/Chicago Medical School, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarksville Emergency Group PCGroup PAC ID 6507277423, 149 clinicians
Cook CountyGroup PAC ID 2860398088, 770 clinicians

Practice addresses (Care Compare)

1701 S Creasy LN
Franciscan Health Lafayette East
Lafayette, IN 47905-4972
Phone (765) 502-4000

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
  • Franciscan Health Lafayette Hospital, Lafayette, IN, CCN 150109
  • John H Stroger Jr Hospital Hospital, Chicago, IL, CCN 140124

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

Merit-based Incentive Payment System (MIPS)

Final score
95.11 of 100Reported as group
Quality
74.7
Promoting interoperability
100
Improvement activities
40
Cost
85.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125074524ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County Emergency Medicine CurrentSince Aug 22, 2023 Accepting new patients
Endeavor Health Medical Group CurrentSince May 17, 2023 Accepting new patients
Community First Healthcare of Illinois, Inc. Emergency Medicine Current Accepting new patients
Endeavor Health Medical Group Emergency Medicine CurrentSince May 17, 2023 Accepting new patients
Cook County CurrentSince Aug 22, 2023 Accepting new patients
Community First Healthcare of Illinois, Inc. CurrentSince Mar 4, 2024 Accepting new patients
Cook County Current Accepting new patients
Clarksville Emergency Group, PC Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients
Community First Healthcare of Illinois, Inc. CurrentSince Mar 4, 2024 Accepting new patients

Locations

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

5645 W Addison St
Chicago, IL 60634
Phone (773) 282-7000

9532 Eagle Way
Chicago, IL 60678

1969 W Ogden Ave
Chicago, IL 60612
Phone (312) 864-3600

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

1141 Hospital Dr NW
Corydon, IN 47112
Phone (812) 738-7830

1701 S Creasy Ln
Lafayette, IN 47905
Phone (765) 502-4400

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 13

Hospital & facility affiliations 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1013578475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE STE 1223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011700",
            "telephone_number": "847-570-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "EMERGENCY MEDICINE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011700",
            "telephone_number": "847-570-2114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1969 W Ogden Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123765",
            "country_code": "US",
            "telephone_number": "312-864-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUBOULEIX",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-26",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036161095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.