Michelle M. Boudreau, D.O.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

17443 Issued in CA

Practice address

11215 Metro Pkwy Ste 1
Fort Myers, FL 33966-1206

Phone

(239) 208-2212

NPI assigned

Jun 1, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 12

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CT, NY, FL, WA, OR, MT, OH, TX, SC, GA, CA, IN12 enrollments

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 12

Specialty

Neurology

Education

Philadelphia College of Osteopathic Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cep America - Neurology PC 60 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corona Regional Medical Center Hospital, Corona, CA, CCN 050329

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations (25 of 47)

Interoperability endpoints

• Direct secure messaging: mboudreau33021@lakeland.midirect.net
• Direct secure messaging: mboudreau@crhn.cernerdirect.com
• Direct secure messaging: mboudreau573192@direct.emplifyhealth.org

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.

• Cep America - Neurology PC

  • Neurology Physician
  • Santa Barbara, CA
  • NPI 1225569346

  CA, Neurology

  Medicare reassignment Care Compare group NPD
• Cep America - Neurology PC

  • Psychiatry Physician
  • Silverdale, WA
  • NPI 1669223830

  WA

  Medicare reassignment Care Compare group NPD
• Cep America - Neurology PC

  • Neurology Physician
  • Terre Haute, IN
  • NPI 1174132708

  IN

  Medicare reassignment Care Compare group
• Nchmd Inc

  • Hematology & Oncology Physician
  • Naples, FL
  • NPI 1831120195

  FL

  Medicare reassignment NPD
• Benefis Hospitals Inc

  • Multi-Specialty Clinic/Center
  • Great Falls, MT
  • NPI 1780968974

  MT

  Medicare reassignment NPD
• Columbus Ambulatory Healthcare Services, Inc.

  • Family Medicine Physician
  • Columbus, GA
  • NPI 1790733244

  Family Medicine, GA

  Medicare reassignment NPD
• Emergency and Acute Care Medical Corporation

  • Emergency Medicine Physician
  • San Diego, CA
  • NPI 1437103942

  CA

  Medicare reassignment NPD
• Good Samaritan Hospital Medical Center

  • Physician Assistant
  • West Islip, NY
  • NPI 1518901180

  NY

  Medicare reassignment NPD
• Hospital Medicine Associates LLC

  • Hospitalist Physician
  • Baton Rouge, LA
  • NPI 1093758781

  CT, Family Medicine

  Medicare reassignment NPD
• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272

  Family Medicine, OR

  Medicare reassignment NPD
• Legacy Emanuel Hospital & Health Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1831112358

  OR

  Medicare reassignment NPD
• Legacy Good Samaritan Hospital and Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1780608216

  OR

  Medicare reassignment NPD

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

• Uhs-Corona Inc

  • General Acute Care Hospital
  • Corona, CA
  • NPI 1457347239

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1346534864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11215 METRO PKWY STE 1",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661206",
            "telephone_number": "239-208-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11215 METRO PKWY STE 1",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661206",
            "telephone_number": "239-208-2212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 S Cedar Crest Blvd Ste 405",
            "address_purpose": "LOCATION",
            "city": "Allentown",
            "state": "PA",
            "postal_code": "181036224",
            "country_code": "US",
            "telephone_number": "610-402-8420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1250 S Cedar Crest Blvd Ste 405",
            "address_purpose": "LOCATION",
            "city": "Allentown",
            "state": "PA",
            "postal_code": "181036224",
            "country_code": "US",
            "telephone_number": "610-402-8420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "630 Eaton Ave",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "OH",
            "postal_code": "450132767",
            "country_code": "US",
            "telephone_number": "513-867-2000",
            "fax_number": "513-867-2119",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "172 Kinsley St",
            "address_purpose": "LOCATION",
            "city": "Nashua",
            "state": "NH",
            "postal_code": "030603648",
            "country_code": "US",
            "telephone_number": "603-882-3000",
            "fax_number": "603-889-3774",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 N Gantenbein Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271623",
            "country_code": "US",
            "telephone_number": "503-413-8407",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2790 Clay Edwards Dr Ste 1235",
            "address_purpose": "LOCATION",
            "city": "North Kansas City",
            "state": "MO",
            "postal_code": "641163276",
            "country_code": "US",
            "telephone_number": "816-472-5157",
            "fax_number": "816-472-7201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "MICHELLE",
        "middle_name": "M.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-01",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "DO191076",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "OD019097",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NH",
            "license": "18849",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "ND",
            "license": "15039",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OH",
            "license": "34.013330",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "5101023728",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CT",
            "license": "51008",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "TM00756",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "293760",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MO",
            "license": "2020005820",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "OS15070",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "17443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3116006",
            "state": "NH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mboudreau632301@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "630 Eaton Ave",
            "city": "Hamilton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450132767",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "630 Eaton Ave",
            "city": "Hamilton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450132767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nestor Botta Gonzalez
• Bottoms Up Medical Systems Inc.
• James Bottoms, PHARMACIST
• Axel Bouchard, PHD
• Nancy Ellen Bouchard, DDS
• Ann Boudreaux, M.D.
• Denise April Bounds, RPAC
• Donald Bounds, PA
• Robert Sidney Bourgeois, M.D.
• Pierre Bourgon, M.D.

• All providers in Fort Myers, FL
• Neurology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; 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.