Emily Brooke Boucher, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.006744RX

Practice address

3737 Southern Blvd
Boonshoft BLD. Floor E
Kettering, OH 45429

Phone

(937) 294-1489

NPI assigned

Nov 13, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

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

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kettering Independent Medical Group Inc 699 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360
• Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
• Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
• Kettering Health Miamisburg Hospital, Miamisburg, OH, CCN 360239
• Kettering Health Greene Memorial Hospital, Xenia, OH, CCN 360026

Merit-based Incentive Payment System (MIPS)

Final score

81.34 of 100Reported as group

Quality

63.67

Promoting interoperability

100

Improvement activities

40

Cost

74.14

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865

  OH

  Medicare reassignment Care Compare group
• Alliance Physicians Inc

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572

  OH

  Medicare reassignment NPD
• Alliance Physicians Inc

  • Hospitalist Physician
  • Kettering, OH
  • NPI 1023409257
  NPD

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

• Beavercreek Medical Center

  • General Acute Care Hospital
  • Beavercreek, OH
  • NPI 1760764849

  Hospital

  Care Compare affiliation
• Dayton Osteopathic Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1053339507

  Hospital

  Care Compare affiliation
• Greene Memorial Hospital Inc

  • General Acute Care Hospital
  • Xenia, OH
  • NPI 1255317848

  Hospital

  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Kettering, OH
  • NPI 1043233984

  Hospital

  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Miamisburg, OH
  • NPI 1316966518

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1255933263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1306",
            "fax_number": "937-522-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 SOUTHERN BLVD",
            "address_2": "BOONSHOFT BLD. FLOOR E",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "45429",
            "telephone_number": "937-294-1489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER",
        "first_name": "EMILY",
        "middle_name": "BROOKE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-13",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "1160683",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "50.006744RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eboucher629925@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3737 Southern Blvd",
            "address_2": "Boonshoft Bld. Floor E",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "45429",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3737 Southern Blvd",
            "address_2": "Boonshoft Bld. Floor E",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "45429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thomas Bonifield
• Jamie Bonner
• Sandra Bontatibus, CRNA
• William J Booth, PA-C
• Jonathan A Borden, MD
• Peter A Bouz, MD
• Kristie Bovee, MD
• Shelby Diane Bowers
• Annette Bowling
• Ryan M. Box, D.O.

• All providers in Kettering, OH
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.