Benjamin Boubli

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

027638 Issued in NY

Practice address

5902 18TH Ave
Brooklyn, NY 11204-2201

Phone

(347) 625-7557

NPI assigned

Nov 25, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

State University of New York Downstate Medical Center, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Urgent Care PCGroup PAC ID 2163675372, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: bboubli1649447@nychhc.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 and National Provider Directory roles.

• Community Urgent Care PC

  • Urgent Care Clinic/Center
  • Brooklyn, NY
  • NPI 1295001576
  Medicare reassignment Care Compare group
• Maimonides Faculty Practice Plan

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1053344846
  Medicare reassignment
• W Medical LLC

  • Clinic/Center
  • Brooklyn, NY
  • NPI 1831968676
  Medicare reassignment

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

{
    "created_epoch": "1637798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1205593167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 HAWTHORNE ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5902 18TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112042201",
            "telephone_number": "347-625-7557"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "667 Myrtle Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112054180",
            "country_code": "US",
            "telephone_number": "347-625-7557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUBLI",
        "first_name": "BENJAMIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-25",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "027638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fouad Georges Bou Harb, MD
• Jad Bou Monsef, M.D.
• Ihsane Boualaoui, FNP
• Anne Bretagne Boubert- Saint Jour, PMHNP-BC
• Carline Boubert, PA
• Lorraine Boucaud-Currie, LMSW
• Danielle Elizabeth Boucaud, MD
• Jeffrey Bouchard-Burns, MD
• Courtney Bouchard
• Sherly Bouche

• Physician Assistant in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; 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.