NPIMap

Individual provider Active NPI

Nan M Boucher, ANP

  • Gerontology Nurse Practitioner
  • Lewiston, ME
National Provider Identifier
1033157227
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
CNP81044 Issued in ME
Practice address
99 Campus Ave
Suite 201
Lewiston, ME 04240-6045
Phone
(207) 777-8810
Fax
(207) 777-8155
NPI assigned
Jun 2, 2006
Last updated
Nov 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AP081044 ME
Gerontology Nurse Practitioner 363LG0600X CNP81044 ME Primary

Addresses

Primary practice location

99 Campus Ave
Suite 201
Lewiston, ME 04240-6045

Mailing address

PO Box 95000 LBX 7650
Philadelphia, PA 19195-0001

Other identifiers 2

IdentifierTypeStateIssuer
432184299MedicaidME
30347091MedicaidNH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nboucher1149631@direct.bsmhealth.org St. Mary's Regional Medical Center

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20060718000067 ME Practitioner - Nurse Practitioner 6709892847 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy HospitalGroup PAC ID 6103737812, 307 clinicians

Practice addresses (Care Compare)

40 Park Rd
Westbrook, ME 04092-3188
Phone (207) 857-8174

43 Baxter Blvd
Suite 2
Portland, ME 04101-1823
Phone (207) 771-1717

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R028338MEMDFamily Nurse Practitioner
AP081044MEMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital CurrentSince Apr 30, 2023 Accepting new patients
Mercy Hospital CurrentSince Apr 30, 2023 Accepting new patients
St. Mary's Regional Medical Center CurrentSince Jul 18, 2011 Accepting new patients
Mercy Hospital Current Accepting new patients
St. Mary's Regional Medical Center CurrentSince Jul 18, 2011 Accepting new patients

Locations

100 Campus Ave
Ste 208
Lewiston, ME 04240
Phone (207) 777-8974

93 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3715

99 Campus Ave
Ste 201
Lewiston, ME 04240
Phone (207) 777-5300

43 Baxter Blvd
Portland, ME 04101
Phone (207) 771-1717

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

Organizations & group practices 5

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.

Hospital & facility affiliations 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1033157227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95000 LBX 7650",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191950001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 CAMPUS AVE",
            "address_2": "SUITE 201",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042406045",
            "telephone_number": "207-777-8810",
            "fax_number": "207-777-8155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER",
        "first_name": "NAN",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "ME",
            "license": "AP081044",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "ME",
            "license": "CNP81044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432184299",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30347091",
            "state": "NH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nboucher1149631@direct.bsmhealth.org",
            "affiliation": "Y",
            "affiliationName": "St. Mary's Regional Medical Center",
            "address_1": "99 Campus Ave",
            "address_2": "Suite 201",
            "city": "Lewiston",
            "state": "ME",
            "country_code": "US",
            "postal_code": "042406045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lewiston, ME

Sources for this page

Verify at the official NPI Registry.