Active NPI
Donnie D Bouchard, DO
- Pediatrics Physician
- Hartford, MI
National Provider Identifier
1306923313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 5101011443
- Practice address
- 63559 60TH Ave
Hartford, MI 49057-8662 - Phone
- (269) 270-9332
- Fax
- (269) 312-8283
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5101011443 | MI | Primary |
Addresses
Primary practice location
63559 60TH Ave
Hartford, MI 49057-8662
Mailing address
4408 S Westnedge Ave
Kalamazoo, MI 49008-3210
Phone (269) 270-9332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan Enterprises Inc. | Pediatrics | Past | Accepting new patients |
| Ascension Borgess Lee Hospital | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Critical Access Hospital
- Dowagiac, MI
- NPI 1194771030
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614211200000",
"number": "1306923313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4408 S WESTNEDGE AVE",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490083210",
"telephone_number": "269-270-9332",
"fax_number": "269-312-8283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63559 60TH AVE",
"city": "HARTFORD",
"state": "MI",
"postal_code": "490578662",
"telephone_number": "269-270-9332",
"fax_number": "269-312-8283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHARD",
"first_name": "DONNIE",
"middle_name": "D",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2021-02-25",
"certification_date": "2021-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "5101011443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hartford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.