NPIMap

Individual provider Active NPI

Peter Antoune Joseph Bou-Daher, PA-C

  • Medical Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1285821470
Registry record updated Mar 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA1069 Issued in NV
Practice address
5785 Centennial Center Blvd.
Las Vegas, NV 89149
Phone
(702) 383-2000
Fax
(775) 751-2323
NPI assigned
Oct 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA1069 NV Primary

Addresses

Primary practice location

5785 Centennial Center Blvd.
Las Vegas, NV 89149

Mailing address

1800 W. Charleston Blvd.
Las Vegas, NV 89102
Phone (702) 383-2000

Other identifiers 1

IdentifierTypeStateIssuer
1285821470MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080117000332 NV Practitioner - Physician Assistant 3577644301 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone (702) 383-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Center of Southern Nevada CurrentSince Mar 1, 2022 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Mar 1, 2022 Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients
Intermountain Medical Holdings Nevada Inc Past Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients

Locations

595 W Lake Mead Pkwy
Henderson, NV 89015
Phone (702) 566-5500

5785 Centennial Center Blvd
Ste 190
Las Vegas, NV 89149
Phone (702) 383-6270

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

1280 E Calvada Blvd
Pahrump, NV 89048
Phone (775) 751-3377

Organizations & group practices 8

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 12

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": "1191283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647129600000",
    "number": "1285821470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 W. CHARLESTON BLVD.",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89102",
            "telephone_number": "702-383-2000",
            "fax_number": "702-671-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5785 CENTENNIAL CENTER BLVD.",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89149",
            "telephone_number": "702-383-2000",
            "fax_number": "775-751-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOU-DAHER",
        "first_name": "PETER",
        "middle_name": "ANTOUNE JOSEPH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-02",
        "last_updated": "2022-03-13",
        "certification_date": "2022-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA1069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285821470",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.