Mikki Smith Bouquet, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

307924 Issued in LA

Practice address

8415 Goodwood Blvd Ste 202
Baton Rouge, LA 70806-7851

Phone

(225) 765-8013

Fax

(225) 765-2033

NPI assigned

Jun 22, 2015

Last updated

Feb 5, 2024By 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 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in LA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mbouquet12552@direct.casso.us.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.

• Our Lady of the Lake Physician Group LLC

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  • Baton Rouge, LA
  • NPI 1033494943

  Pediatrics

  Medicare reassignment NPD
• Our Lady of the Lake Physician Group LLC

  dba Our Lady of the Lake Children's Health Developmental Center at McMains

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  • NPI 1235912502
  NPD
• Our Lady of the Lake Physician Group, LLC

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  • NPI 1588062079
  NPD
• Health Care Centers in Schools

  dba HCS-Istrouma High School

  • Clinic/Center
  • Baton Rouge, LA
  • NPI 1467678045
  NPD (past)
• Our Lady of the Lake Physician Group LLC

  dba OLOL Physician Surgical Specialty

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  NPD (past)
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  dba Woman's Hospital

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  • NPI 1912943184
  NPD (past)

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

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1144602590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "225-765-8013",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8415 GOODWOOD BLVD STE 202",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067851",
            "telephone_number": "225-765-8013",
            "fax_number": "225-765-2033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1676 Glasgow Ave",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708088631",
            "country_code": "US",
            "telephone_number": "225-924-7709",
            "fax_number": "225-926-9546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUQUET",
        "first_name": "MIKKI",
        "middle_name": "SMITH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-22",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "PGY.202956",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "307924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbouquet12552@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mbouquet12552@direct.casso.us.com",
            "address_1": "8415 Goodwood Blvd Ste 202",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708067851",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epihosted.com/FHIRPoxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "8415 Goodwood Blvd Ste 202",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708067851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Julia G Bounds, CRNA
• Bountiful Blessings LLC
• Bountiful Blessings LLC
• Bountiful Blessings LLC
• Bountiful Blessings LLC
• Ibrahim Bourakba
• Hester Catherine Bourdier, SLP
• Angele D. Bourg, M.D.
• Cheryl Larrieu Bourg, R.PH.
• Elizabeth A Bourg

• Pediatrics Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.