Jason Bashir Boudjouk, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD12133 Issued in RI

Practice address

190 Commerce Dr
Warwick, RI 02886-2430

Phone

(401) 921-5970

Fax

(401) 921-5973

NPI assigned

Jun 19, 2006

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

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elara Caring Home health agency, Warwick, RI, CCN 417035
• Kent County Memorial Hospital Hospital, Warwick, RI, CCN 410009
• The Miriam Hospital Hospital, Providence, RI, CCN 410012
• South County Hospital Inc Hospital, Wakefield, RI, CCN 410008
• Women & Infants Hospital of Rhode Island Hospital, Providence, RI, CCN 410010

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jboudjouk@direct.carene.org
• Direct secure messaging: jboudjouk@kent.cernerdirect.carene.org

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.

• Dr. K. Humulock, Internal Medicine Inc.

  • Internal Medicine Physician
  • Warwick, RI
  • NPI 1265770937
  NPD (past)

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

• Assisted Daily Living, Inc

  dba Elara Caring

  • Home Health Agency
  • Warwick, RI
  • NPI 1831196955
  Care Compare affiliation
• Kent County Memorial Hospital

  dba Kent County Hospital Rehab Unit

  • Rehabilitation Hospital Unit
  • Warwick, RI
  • NPI 1023017944
  Care Compare affiliation
• Kent County Memorial Hospital

  • General Acute Care Hospital
  • Warwick, RI
  • NPI 1386643294
  Care Compare affiliation
• South County Hospital Healthcare System

  • General Acute Care Hospital
  • Wakefield, RI
  • NPI 1952366106
  Care Compare affiliation
• The Miriam Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1487649430
  Care Compare affiliation
• Women & Infants Hospital of Rhode Island

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1447233788
  Care Compare affiliation

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628726400000",
    "number": "1255376455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ASHLEY DR",
            "city": "LINCOLN",
            "state": "RI",
            "postal_code": "028651434",
            "telephone_number": "401-334-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 COMMERCE DR",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862430",
            "telephone_number": "401-921-5970",
            "fax_number": "401-921-5973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDJOUK",
        "first_name": "JASON",
        "middle_name": "BASHIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD12133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI KENT HOSPITAL PBO",
            "identifier": "1396864542",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Botelho
• Nicholas Alexander Bottella, LCDP
• Melissa Bouchard, RN
• Victoria Barrett Bouchard, ATC
• Arianna Boucher, BIRTH DOULA
• Anissa Boudreau, DC
• Lauren Boulanger
• Nayla Cecile Bouramia
• Peter Armand Bourdeau, DDS
• Julie A Bourgault

• Internal Medicine Physician in Warwick, RI
• Providers in Warwick, RI by specialty
• Internal Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2021; 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.