Jessica Faye Bouchard, RPA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

013312-1 Issued in NY

Practice address

4110 Medical Center Dr
Fayetteville, NY 13066-6613

Phone

(315) 663-0100

Fax

(315) 663-0052

NPI assigned

Jul 5, 2009

Last updated

Nov 25, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Albany Medical College of Union University, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr. Fazeli and Dr. Broumand LLCGroup PAC ID 0446358063, 11 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

• Dr. Fazeli & Dr. Broumand LLC

  • Dermatology Physician
  • Fayetteville, NY
  • NPI 1336235639
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1246752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416873600000",
    "number": "1023247608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 MEDICAL CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666613",
            "telephone_number": "315-663-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 MEDICAL CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666613",
            "telephone_number": "315-663-0100",
            "fax_number": "315-663-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHARD",
        "first_name": "JESSICA",
        "middle_name": "FAYE",
        "name_prefix": "Mrs.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-05",
        "last_updated": "2014-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "013312-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dil Bhujel
• Biby Rajan-George M.D PLLC (Biby Rajan-George)
• Allan M Birnbaum, MD
• Patricia Jean Boehlert
• Mary Beth Borio, DPT, MS, CERT MDT
• Tara Brackley, OD
• Carole S. Bragdon, MSW, LCSW
• Denis F Branson, MD
• Susan Hartman Brenizer, M.A., LMFT (LICENSED
• Erica L Brier-Kennedy, LMFT

• Medical Physician Assistant in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.