Individual provider Active NPI

Bruce V Ouellette, M.D.

  • Neurology Physician
  • Port St Lucie, FL
National Provider Identifier
1285619221
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
ME84932 Issued in FL
Practice address
10000 SW Innovation Way
Port St Lucie, FL 34987-2111
Phone
(954) 345-8100
NPI assigned
Dec 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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 ME84932 FL Primary

Addresses

Primary practice location

10000 SW Innovation Way
Port St Lucie, FL 34987-2111

Mailing address

383 SE Mulberry Way
Port St Lucie, FL 34984-2310
Phone (850) 865-2644

Other identifiers 1

IdentifierTypeStateIssuer
265032100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20100115000527 FL Practitioner - Neurology 4284776154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Louisiana State University School of Medicine in New Orleans, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Martin Memorial Medical Center IncGroup PAC ID 2961300611, 514 clinicians

Practice addresses (Care Compare)

10000 SW Innovation Way
Port Saint Lucie, FL 34987-2111
Phone (772) 345-8100

Hospital & facility affiliations

  • Cleveland Clinic Martin North Hospital Hospital, Stuart, FL, CCN 100044

Merit-based Incentive Payment System (MIPS)

Final score
92.26 of 100Reported as apm
Quality
80.2
Promoting interoperability
99.24
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Martin Memorial Medical Center Inc CurrentSince Jan 1, 2025 Accepting new patients

Locations

10000 SW Innovation Way
Port St Lucie, FL 34987
Phone (772) 288-5853

200 SE Hospital Ave
Stuart, FL 34994
Phone (772) 223-5618

509 SE Riverside Dr
Ste 305
Stuart, FL 34994
Phone (772) 221-2003

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1285619221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "383 SE MULBERRY WAY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349842310",
            "telephone_number": "850-865-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 SW INNOVATION WAY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872111",
            "telephone_number": "954-345-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OUELLETTE",
        "first_name": "BRUCE",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2023-06-07",
        "certification_date": "2023-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME84932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265032100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.