Active NPI
Andre P Boulogne, DC
- Chiropractor
- Brighton, MA
National Provider Identifier
1225175458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1878
- Practice address
- 167 Corey Road
Brighton, MA 02135 - Phone
- (617) 731-5000
- Fax
- (617) 731-3945
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1878 | MA | Primary |
Addresses
Primary practice location
167 Corey Road
Brighton, MA 02135
Mailing address
167 Corey Road
Brighton, MA 02135
Phone (617) 731-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110411000151 | MA | Practitioner - Chiropractic | 1254515687 | Practice locations: Brookline, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
32 Kent St
Brookline, MA 02445-7943
Phone (617) 731-5000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1878 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225175458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "167 COREY ROAD",
"city": "BRIGHTON",
"state": "MA",
"postal_code": "02135",
"telephone_number": "617-731-5000",
"fax_number": "617-731-3945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "167 COREY ROAD",
"city": "BRIGHTON",
"state": "MA",
"postal_code": "02135",
"telephone_number": "617-731-5000",
"fax_number": "617-731-3945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULOGNE",
"first_name": "ANDRE",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MA",
"license": "1878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brighton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.