Individual provider Active NPI

Brian Robert Boulay, MD

  • Gastroenterology Physician
  • Chicago, IL
National Provider Identifier
1023103439
Registry record updated Jun 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036.125568 Issued in IL
Practice address
1740 W Taylor St
Uic Medical Center, Section of Digestive Diseases
Chicago, IL 60612-0199
Phone
(312) 355-4270
Fax
(312) 996-5103
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2010

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 13031 NH
Gastroenterology Physician 207RG0100X A107914 CA
Gastroenterology Physician 207RG0100X 036.125568 IL Primary

Addresses

Primary practice location

1740 W Taylor St
Uic Medical Center, Section of Digestive Diseases
Chicago, IL 60612-0199

Mailing address

3920 N Sheridan Rd
Apt 504
Chicago, IL 60613-5493
Phone (802) 356-7432

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101214000719 IL Practitioner - GastroenterologyPractitioner - Internal Medicine 4183811359 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1740 W Taylor St
Chicago, IL 60612-7232

1855 W Taylor St
Chicago, IL 60612-7242
Phone (312) 996-6590

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy33
Upper gastrointestinal (GI) endoscopy for acid reflux154

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A107914CAMDGastroenterology Physician
036.125568ILMDGastroenterology Physician
13031NHMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Aug 1, 2010 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Aug 1, 2010 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Board of Trustees of the University of Illinois Past Accepting new patients

Locations

1740 W Taylor St
Ste 1400
Chicago, IL 60612
Phone (312) 996-3900

845 W Wilson Ave
Chicago, IL 60640
Phone (312) 744-1295

7732 Solutions Ctr
Chicago, IL 60677

1855 W Taylor St
Chicago, IL 60612
Phone (312) 996-6582

1740 W Taylor St
Chicago, IL 60612
Phone (312) 355-4000

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

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 1

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275523200000",
    "number": "1023103439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 N SHERIDAN RD",
            "address_2": "APT 504",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606135493",
            "telephone_number": "802-356-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST",
            "address_2": "UIC MEDICAL CENTER, SECTION OF DIGESTIVE DISEASES",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606120199",
            "telephone_number": "312-355-4270",
            "fax_number": "312-996-5103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULAY",
        "first_name": "BRIAN",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2010-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NH",
            "license": "13031",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A107914",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036.125568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.