Kelly J Bouchonville, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

124548 Issued in IA

Practice address

200 Hawkins Dr
Iowa City, IA 52242-1009

Phone

(319) 356-8133

Fax

(319) 356-2999

NPI assigned

Mar 24, 2023

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

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Yale University School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State University of IowaGroup PAC ID 7618884230, 1,886 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Iowa Hospital & Clinics Dialysis Dialysis facility, Iowa City, IA, CCN 162306
• University of Iowa Hospital & Clinics - Grinnell Dialysis facility, Grinnell, IA, CCN 163507
• University of Iowa Hospital & Clinics Hospital, Iowa City, IA, CCN 160058

Merit-based Incentive Payment System (MIPS)

Final score

92.38 of 100Reported as group

Quality

99.62

Promoting interoperability

100

Improvement activities

40

Cost

74.99

Merit-based Incentive Payment System (MIPS)

Final score

80.02 of 100Reported as group

Quality

75.68

Promoting interoperability

78

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• State University of Iowa

  • Family Medicine Physician
  • Iowa City, IA
  • NPI 1477554814
  Medicare reassignment Care Compare group NPD
• State University of Iowa

  • Family Medicine Physician
  • Iowa City, IA
  • NPI 1730138579
  NPD
• State University of Iowa

  • Student Health Clinic/Center
  • Iowa City, IA
  • NPI 1285635664
  NPD (past)

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

• State University of Iowa

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Iowa City, IA
  • NPI 1639157415

  Dialysis facility

  Care Compare affiliation Name & address match
• State University of Iowa

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Grinnell, IA
  • NPI 1881679371

  Dialysis facility

  Care Compare affiliation Name & address match
• University of Iowa Hospital and Clinics

  • General Acute Care Hospital
  • Iowa City, IA
  • NPI 1265698948

  Dialysis facility

  Care Compare affiliation Name & address match
• State University of Iowa

  • General Acute Care Hospital
  • Iowa City, IA
  • NPI 1376544320
  Care Compare affiliation

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

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755734400000",
    "number": "1154024586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-356-8133",
            "fax_number": "319-356-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-356-8133",
            "fax_number": "319-356-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHONVILLE",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-24",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14257",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "124548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joni Bosch, PHD ARNP
• Annaliese Bosco, M.D.
• Drew Bossen, LPT
• Kathryn Leigh Bossen, PT,DPT
• Breana Bottjen, OFNC
• Joel Boudreaux, MD
• Taylor Marie Boudreaux, MD
• Sarag Aboujafar Boukhar, M.D
• Rob Boulter
• Jane F. Bourgeois, D.C., P.C.

• Physician Assistant in Iowa City, IA
• Providers in Iowa City, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; 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.