John Mark Bouchillon, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD.35462 Issued in AL

Practice address

559 Vincent St
Attn: 21 Hcos/Sgoc - Pediatrics
Peterson AFB, CO 80914-1540

Phone

(719) 556-1197

Fax

(877) 813-1756

NPI assigned

Apr 15, 2015

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

Medicare fee-for-service enrollment

Enrolled in AL

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jbouchillon245231@direct.childrenscolorado.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.

• University of Alabama Health Services Foundation, PC.

  • Multi-Specialty Clinic/Center
  • Birmingham, AL
  • NPI 1093768723
  Medicare reassignment NPD
• Castle Rock Pediatrics PLLC

  • Primary Care Clinic/Center
  • Castle Rock, CO
  • NPI 1548289614
  NPD (past) Authorized official
• Children's Hospital Colorado

  • Clinical Social Worker
  • Aurora, CO
  • NPI 1174282776
  NPD
• University of Alabama Health Services Foundation, PC

  dba UAHSF Department of Pediatrics

  • Pediatrics Physician
  • Birmingham, AL
  • NPI 1356377576
  NPD

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568246400000",
    "number": "1386030476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST",
            "address_2": "ATTN: 21 HCOS/SGOC - PEDIATRICS",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141540",
            "telephone_number": "719-556-1197",
            "fax_number": "877-813-1756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST",
            "address_2": "ATTN: 21 HCOS/SGOC - PEDIATRICS",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141540",
            "telephone_number": "719-556-1197",
            "fax_number": "877-813-1756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHILLON",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-15",
        "last_updated": "2019-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "MD.35462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raymond Alfred Bailey, PT
• Keith Andrew Baker, M.D.
• Mark Ballesteros, PHARM.D.
• Marcus Beyerle, DMD
• Zachary Edward Bishop, PHARMD
• Monique Boyle
• John Scott Brooks, M.D., MPH
• Robert R Burnett, D.D.S.
• Amy Ann Campbell, D.M.D.
• Shane Carr, DPT

• Pediatrics Physician in Peterson AFB, CO
• Providers in Peterson AFB, CO by specialty
• Pediatrics Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; 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.