T. Glen Bouder, MD

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

0101244705 Issued in VA

Practice address

1840 Amherst St
Winchester, VA 22601-2808

Phone

(540) 536-8874

Fax

(540) 536-7847

NPI assigned

Aug 23, 2005

Last updated

May 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Critical Care (Intensivists)Also: Internal Medicine, Pulmonary Disease

Education

West Virginia University School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Winchester Medical CenterGroup PAC ID 0244134021, 313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Winchester Medical Center Hospital, Winchester, VA, CCN 490005

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tbouder124061@soc.inova.org
• Direct secure messaging: tbouder124061@valleyhealth.direct-ci.com

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.

• Winchester Medical Center

  dba Valley Intensivists

  • Critical Care Medicine (Internal Medicine) Physician
  • Winchester, VA
  • NPI 1679711261
  Medicare reassignment Care Compare group
• Valley Physician Enterprise, Inc

  • Surgery Physician
  • Winchester, VA
  • NPI 1538316203
  Medicare reassignment NPD
• Lung Sleep and Critical Care Consultants, PC

  • Pulmonary Disease Physician
  • York, PA
  • NPI 1083607352
  NPD (past) Authorized official
• Shenandoah Valley Pathology Laboratories Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Winchester, VA
  • NPI 1447363114
  NPD
• Valley Physician Enterprise, Inc.

  dba Valley Health Fertility

  • Obstetrics & Gynecology Physician
  • Winchester, VA
  • NPI 1255222535
  NPD
• Valley Physician Enterprise, Inc.

  dba Valley Health Pulmonary and Sleep Specialists

  • Pulmonary Disease Physician
  • Winchester, VA
  • NPI 1578021317
  NPD
• Winchester Medical Center

  dba Valley Health Pediatrics Department of Winchester Medical Center

  • Pediatrics Physician
  • Winchester, VA
  • NPI 1013874742
  NPD
• Winchester Medical Center

  dba Valley Health Pulmonary and Sleep Specialists Department of Winchester Medical Center

  • Pulmonary Disease Physician
  • Winchester, VA
  • NPI 1336951581
  NPD
• Winchester Medical Center

  dba Valley Health Pulmonary Specialists

  • Pulmonary Disease Physician
  • Winchester, VA
  • NPI 1053814129
  NPD (past)

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

• Winchester Medical Center

  • General Acute Care Hospital
  • Winchester, VA
  • NPI 1619928017
  Care Compare affiliation
• Winchester Medical Center

  dba Valley Health Laboratories

  • Clinical Medical Laboratory
  • Winchester, VA
  • NPI 1790024909

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1043203318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CAMPUS BLVD STE 100",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012896",
            "telephone_number": "540-536-5100",
            "fax_number": "540-536-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 AMHERST ST",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012808",
            "telephone_number": "540-536-8874",
            "fax_number": "540-536-7847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 Campus Blvd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Winchester",
            "state": "VA",
            "postal_code": "226012872",
            "country_code": "US",
            "telephone_number": "540-536-5980",
            "fax_number": "540-536-5979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUDER",
        "first_name": "T.",
        "middle_name": "GLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "VA",
            "license": "0101244705",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "PA",
            "license": "MD051542L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043203318",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tbouder124061@soc.inova.org",
            "affiliation": "N",
            "address_1": "1840 Amherst St",
            "city": "Winchester",
            "state": "VA",
            "country_code": "US",
            "postal_code": "226012808",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tbouder124061@soc.inova.org",
            "affiliation": "N",
            "address_1": "190 Campus Blvd Ste 201",
            "city": "Winchester",
            "state": "VA",
            "country_code": "US",
            "postal_code": "226012872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mena Botros, DDS
• D. Gregory Bott, M.D.
• Jeffrey S Botta, DPT
• Kelly Ann Botta, PA-C
• Timothy Bouck, MD
• Jessica Brunot Bouldin, CLC, CD
• Marissa Boutin
• Steven S Bowen
• Timothy Keefe Bowers Jr., MD
• Tina Bowers, PHARM. D

• Critical Care Medicine (Internal Medicine) Physician in Winchester, VA
• Providers in Winchester, VA by specialty
• Critical Care Medicine (Internal Medicine) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.