Pibi Jean Bouda

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

2023005006 Issued in MO

Practice address

3320 Marshall Ave
Saint Louis, MO 63114-4344

Phone

(314) 489-5537

NPI assigned

Feb 13, 2023

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

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MO

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

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Py Medical Services of Mo PCGroup PAC ID 4284075904, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pbouda447641@direct-ehr-ssmhc.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.

• Py Medical Services of Mo PC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1316799042
  Medicare reassignment Care Compare group NPD
• Digestive Health Specialists, LLC

  • Gastroenterology Physician
  • Independence, MO
  • NPI 1801286844
  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  MO

  Medicare reassignment NPD
• Vpa PC

  • Family Medicine Physician
  • Saint Louis, MO
  • NPI 1760706337
  Medicare reassignment
• Harmonycares Complete Health Services, PLLC

  • Family Medicine Physician
  • Jackson, MS
  • NPI 1093543902

  MO

  Medicare reassignment
• Wound Healing Care Specialists Mo Inc

  • Surgery Physician
  • Ellisville, MO
  • NPI 1447143805
  NPD

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

{
    "created_epoch": "1676246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1235836982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 MARSHALL AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631144344",
            "telephone_number": "314-489-5537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 MARSHALL AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631144344",
            "telephone_number": "314-489-5537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12277 DePaul Dr.",
            "address_2": "Suite 500",
            "address_purpose": "LOCATION",
            "city": "Bridgeton",
            "state": "MO",
            "postal_code": "63044",
            "country_code": "US",
            "telephone_number": "314-291-8824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUDA",
        "first_name": "PIBI",
        "middle_name": "JEAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2023005006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NA",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pbouda447641@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pbouda447641@direct-ehr-ssmhc.com",
            "address_1": "12277 DePaul Dr.",
            "address_2": "Suite 500",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "63044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "12277 DePaul Dr.",
            "address_2": "Suite 500",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "63044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Zeena Bou Reslan, MD
• Djamel Bouazza, MD
• Rebecca Boucard
• Linda Trinh Boucher, FNP
• Douglas Bouck, Sr., DC
• Joshua Boudeman, PHARMD
• John Anthony Boudreau, MD
• Arielle Boudreaux, AA
• Victoria Bougeno
• Frank Joseph Bougher, CRNA

• Gerontology Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Gerontology Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.