Individual provider Active NPI

Henda Bouali, MD

  • Rheumatology Physician
  • Vestal, NY
National Provider Identifier
1053495465
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
246796 Issued in NY
Practice address
4417 Vestal Parkway East
Suite 202
Vestal, NY 13850-3556
Phone
(607) 770-7365
Fax
(607) 729-5882
NPI assigned
Oct 24, 2006
Last updated
Sep 19, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 246796 NY Primary

Addresses

Primary practice location

4417 Vestal Parkway East
Suite 202
Vestal, NY 13850-3556

Mailing address

346 Grand Ave
Johnson City, NY 13790-2580
Phone (607) 729-8156

Other identifiers 1

IdentifierTypeStateIssuer
02940054MedicaidNY

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080111000262 NY Practitioner - Rheumatology 0648351080 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

33 -57 Harrison St
Johnson City, NY 13790-2107
Phone (607) 763-6101

4417 Vestal Pkwy E
Vestal, NY 13850-3556
Phone (607) 770-7365

4433 Vestal Pkwy E
Vestal, NY 13850-3556
Phone (607) 771-2220

54 Main St
Candor, NY 13743-1619
Phone (607) 659-7272

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.41 of 100Reported as group
Quality
90.71
Promoting interoperability
99
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
89.14 of 100Reported as group
Quality
86.74
Promoting interoperability
99
Improvement activities
40
Cost
70.09

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
246796NYMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Delaware Valley Hospital, Inc CurrentSince Jan 2, 2024 Accepting new patients
Delaware Valley Hospital, Inc Current Accepting new patients
United Health Services Hospitals, Inc. CurrentSince Dec 18, 2011 Accepting new patients

Locations

33 Lewis Rd
Fl 2
Binghamton, NY 13905
Phone (607) 729-8156

33-57 Harrison St
Johnson City, NY 13790
Phone (607) 763-6412

346 Grand Ave
Johnson City, NY 13790
Phone (607) 729-8156

4417 Vestal Pkwy E
Ste 202
Vestal, NY 13850
Phone (607) 770-7365

4433 Vestal Pkwy E
Vestal, NY 13850
Phone (607) 762-2176

2 Titus Pl
Walton, NY 13856
Phone (607) 865-2197

2 Titus Pl
#13202
Walton, NY 13856
Phone (607) 865-2197

Organizations & group practices 3

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 4

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": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1053495465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "346 GRAND AVE",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902580",
            "telephone_number": "607-729-8156",
            "fax_number": "607-729-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4417 VESTAL PARKWAY EAST",
            "address_2": "SUITE 202",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138503556",
            "telephone_number": "607-770-7365",
            "fax_number": "607-729-5882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUALI",
        "first_name": "HENDA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NY",
            "license": "246796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02940054",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vestal, NY

Sources for this page

Verify at the official NPI Registry.