NPIMap

Individual provider Active NPI

Jeremy Michael Boucher, MD

  • Anesthesiology Physician
  • Oklahoma City, OK
National Provider Identifier
1093853053
Registry record updated Nov 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
23387 Issued in OK
Practice address
11520 Haven Way
Oklahoma City, OK 73120-4616
Phone
(405) 881-7776
NPI assigned
Feb 2, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 23387 OK Primary

Addresses

Primary practice location

11520 Haven Way
Oklahoma City, OK 73120-4616

Mailing address

11520 Haven Way
Oklahoma City, OK 73120-4616
Phone (405) 881-7776

Other identifiers 1

IdentifierTypeStateIssuer
20076550AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20070808000475 OK Practitioner - AnesthesiologyPractitioner - General PracticePractitioner - Addiction Medicine 6608967484 Reassigns benefits to 2 organizations
Practice locations: Oklahoma City, OK

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Addiction Medicine, General Practice
Education
University of Oklahoma College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthomed Staffing LLCGroup PAC ID 9638429178, 373 clinicians

Practice addresses (Care Compare)

8100 S Walker Ave
BLDG C
Oklahoma City, OK 73139-9404
Phone (405) 602-6500

Hospital & facility affiliations

  • Oklahoma Center for Orthopaedic & Multi-SP Hospital, Oklahoma City, OK, CCN 370212
  • SSM Health St Anthony Hospital - Shawnee Hospital, Shawnee, OK, CCN 370149
  • Stillwater Medical Center Hospital, Stillwater, OK, CCN 370049
  • Great Plains Regional Medical Center Hospital, Elk City, OK, CCN 370019
  • Memorial Health Hospital, Lawton, OK, CCN 370056

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Wise Holdings LLC CurrentSince Jan 4, 2020 Accepting new patients
Orthomed Staffing LLC Anesthesiology CurrentSince Aug 16, 2023 Accepting new patients
Anesthesia Medical Professionals, PLLC Anesthesiology CurrentSince Mar 1, 2024 Accepting new patients
St John Macomb-Oakland Hospital Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
St Marys Anesthesia Group Anesthesiology Past Accepting new patients
Anesthesiology Management Inc Anesthesiology Past Accepting new patients
Dean McGee Eye Institute Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

4801 Integris Pkwy
Edmond, OK 73034
Phone (405) 657-3000

4401 S Western Ave
#M
Oklahoma City, OK 73109
Phone (405) 636-7000

5925 NW 139th St
Oklahoma City, OK 73142
Phone (405) 621-8800

11200 N Portland Ave
Oklahoma City, OK 73120
Phone (405) 936-1000

3300 NW Expressway St
Fl 2
Oklahoma City, OK 73112
Phone (405) 251-2815

8100 S Walker Ave
Bldg C
Oklahoma City, OK 73139
Phone (405) 602-6500

3300 NW Expressway St
Oklahoma City, OK 73112
Phone (405) 251-2815

500 S Broadway St
Ste D
Poteau, OK 74953
Phone (918) 564-2270

491 John Young Way
Ste 100
Exton, PA 19341
Phone (443) 907-6068

Organizations & group practices 9

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 9

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": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1093853053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11520 HAVEN WAY",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731204616",
            "telephone_number": "405-881-7776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11520 HAVEN WAY",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731204616",
            "telephone_number": "405-881-7776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER",
        "first_name": "JEREMY",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "23387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20076550A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.