NPIMap

Individual provider Active NPI

William D Boudouris, D.O.

  • Neurology Physician
  • Farmington Hills, MI
National Provider Identifier
1205806577
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
011985 Issued in MI
Practice address
28595 Orchard Lake Rd
Suite 200
Farmington Hills, MI 48334-2977
Phone
(248) 553-0010
Fax
(248) 553-5957
NPI assigned
Jan 26, 2006
Last updated
Sep 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 011985 MI Primary

Addresses

Primary practice location

28595 Orchard Lake Rd
Suite 200
Farmington Hills, MI 48334-2977

Mailing address

28595 Orchard Lake Rd
Suite 200
Farmington Hills, MI 48334-2977
Phone (248) 553-0010

Other identifiers 1

IdentifierTypeStateIssuer
3376564MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20090420000454 MI Practitioner - Neurology 8527115054 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Michigan State University College of Osteopathic Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Glendale Neurological Associates P CGroup PAC ID 5294778833, 40 clinicians

Practice addresses (Care Compare)

28595 Orchard Lake Rd
Suite 200
Farmington Hills, MI 48334-2979
Phone (248) 553-0010

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.34 of 100Reported as group
Quality
75.8
Improvement activities
40
Cost
84.8

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
011985MIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Michigan Aas LLC CurrentSince Jan 26, 2026 Accepting new patients
Glendale Neurological Associates P C Neurology CurrentSince Apr 1, 2009 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1697
  • Direct secure messaging: wboudour@direct.dmc.org
  • Direct secure messaging: wboudouris@mind.gwaydirect.com
  • Direct secure messaging: wboudouris1118294@direct.hfhs.org

Organizations & group practices 2

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 12

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": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1205806577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28595 ORCHARD LAKE RD",
            "address_2": "SUITE 200",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483342977",
            "telephone_number": "248-553-0010",
            "fax_number": "248-553-5957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28595 ORCHARD LAKE RD",
            "address_2": "SUITE 200",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483342977",
            "telephone_number": "248-553-0010",
            "fax_number": "248-553-5957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDOURIS",
        "first_name": "WILLIAM",
        "middle_name": "D",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "011985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3376564",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington Hills, MI

Sources for this page

Verify at the official NPI Registry.