NPIMap

Individual provider Active NPI

Charles Allen Boucher, MD

  • Cardiovascular Disease Physician
  • Boston, MA
National Provider Identifier
1013986801
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
36588 Issued in MA
Practice address
8 Hawthorne PL
Suite 110
Boston, MA 02114-2335
Phone
(617) 726-8511
Fax
(617) 726-9839
NPI assigned
Mar 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 5, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36588 MA
Cardiovascular Disease Physician 207RC0000X 36588 MA Primary

Addresses

Primary practice location

8 Hawthorne PL
Suite 110
Boston, MA 02114-2335

Mailing address

8 Hawthorne PL
Suite 110
Boston, MA 02114-2335
Phone (617) 726-8511

Other identifiers 3

IdentifierTypeStateIssuer
2064227MedicaidMA
705823OtherMATUFTS HEALTH PLAN
M09801OtherMABCBS MA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040709001116 MA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0042298606 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Columbia University College of Physicians and Surgeons, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Massachusetts General Physicians Organization IncGroup PAC ID 2466365820, 3,494 clinicians

Practice addresses (Care Compare)

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

Hospital & facility affiliations

  • Massachusetts General Hospital Hospital, Boston, MA, CCN 220071
  • North Shore Medical Center - Hospital, Salem, MA, CCN 220035
  • Brigham and Women'S Hospital Hospital, Boston, MA, CCN 220110
  • Winchester Hospital Hospital, Winchester, MA, CCN 220105
  • Wentworth-Douglass Hospital Hospital, Dover, NH, CCN 300018

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36588MAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
General Hospital Corp Current Accepting new patients
Massachusetts General Physicians Organization Inc Internal Medicine CurrentSince Jul 1, 1978 Accepting new patients
The General Hospital Corporation CurrentSince Oct 31, 2010 Accepting new patients
Charles a Boucher MD PC Internal Medicine Past Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

57 Prospect St
Nantucket, MA 02554
Phone (508) 228-1200

Interoperability endpoints

  • Direct secure messaging: boucher.charles.mgh@direct.partners.masshiway.net

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209945600000",
    "number": "1013986801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 HAWTHORNE PL",
            "address_2": "SUITE 110",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142335",
            "telephone_number": "617-726-8511",
            "fax_number": "617-726-9839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 HAWTHORNE PL",
            "address_2": "SUITE 110",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142335",
            "telephone_number": "617-726-8511",
            "fax_number": "617-726-9839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER",
        "first_name": "CHARLES",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2008-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "36588",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "36588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2064227",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "705823",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "M09801",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.