Jacqueline D Boutrouille, M.D., P.A.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME 87029 Issued in FL

Practice address

7880 N University Dr
Suite 303
Tamarac, FL 33321-2124

Phone

(954) 340-3000

Fax

(954) 636-8407

NPI assigned

Jun 19, 2006

Last updated

Jan 11, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

PsychiatryAlso: Addiction Medicine

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optum Behavioral Care of North Carolina PCGroup PAC ID 5092120030, 175 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Physician Assistant

State licenses

Practice roles

Locations

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.

• Optum Behavioral Care of North Carolina, PC

  • Counseling Psychologist
  • Sarasota, FL
  • NPI 1033984448
  Medicare reassignment Care Compare group NPD
• Addiction and Recovery Solution,LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Tamarac, FL
  • NPI 1912397043
  NPD (past) Authorized official
• Jacqueline Boutrouille MD PA

  • Psychiatry Physician
  • Tamarac, FL
  • NPI 1720325574
  Authorized official Same address or phone
• Optum Behavioral Care of North Carolina, P.C.

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1861371718
  NPD
• Mindpath Health Florida, PLLC

  • Psychiatry Physician
  • Coral Springs, FL
  • NPI 1467467266
  NPD (past)
• Clinical Solutions of Charleston PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Charleston, SC
  • NPI 1154388924
  NPD (past)

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357862400000",
    "number": "1447295886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7880 N UNIVERSITY DR",
            "address_2": "SUITE 303",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333212124",
            "telephone_number": "954-340-3000",
            "fax_number": "954-636-8407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7880 N UNIVERSITY DR",
            "address_2": "SUITE 303",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333212124",
            "telephone_number": "954-340-3000",
            "fax_number": "954-636-8407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTROUILLE",
        "first_name": "JACQUELINE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D., P.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-19",
        "last_updated": "2013-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME 87029",
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "FL",
            "license": "ME 87029",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268083100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Constance Bonis, OT
• Kinshasa Borland
• Adelyne Bosse, ARNP
• Karen Bossert
• Fafasoraya Bouadjadja
• Maria Boutsikos, DMD
• David Mark Bower, MD
• Alijah Bradley, DDS
• Ted Hugh Brady, D.O.
• Joan Braide

• Psychiatry Physician in Tamarac, FL
• Providers in Tamarac, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; 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.