Antoine A Boudoumit, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

10808 Issued in NV

Practice address

1055 S Wells Ave
Suite 120
Reno, NV 89502-2586

Phone

(775) 329-6300

Fax

(775) 348-3896

NPI assigned

Oct 3, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NV

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Health Alliance

  • Pharmacy
  • Sun Valley, NV
  • NPI 1720728298
  NPD (past)
• Renown Urgent Care LLC

  dba Fernley Urgent Care

  • Family Medicine Physician
  • Fernley, NV
  • NPI 1821043381
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346335940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 S WELLS AVE",
            "address_2": "SUITE 120",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895022586",
            "telephone_number": "775-329-6300",
            "fax_number": "775-348-3896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 S WELLS AVE",
            "address_2": "SUITE 120",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895022586",
            "telephone_number": "775-329-6300",
            "fax_number": "775-348-3896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDOUMIT",
        "first_name": "ANTOINE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "10808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001516008",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003116008",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leticia Vanessa Boten
• Melissa Bott
• Katherine Anne Bottles
• Grace Elizabeth Bottoms
• Gabriel Farid Bou Merhi, MD
• Vanessa Bouey, MS, CFY-SLP
• Serena Bough, IBCLC
• Lisa Boughner
• Novina Boulware-Brown
• Ashley Bousquet, FNP

• Family Medicine Physician in Reno, NV
• Providers in Reno, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.