Gary J Bouchard, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

003223 Issued in NY

Practice address

190 Broadway
Greenlawn, NY 11740-2120

Phone

(732) 668-4192

NPI assigned

Nov 10, 2008

Sex

Male

Sole proprietor

No

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.

• Samaritan Medical Services, P.C.

  • Internal Medicine Physician
  • West Islip, NY
  • NPI 1124184544

  NY

  Medicare reassignment Care Compare group
• Ion Oltean Physician PC

  • Internal Medicine Physician
  • Bayside, NY
  • NPI 1912236811

  NY

  Medicare reassignment

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

• St Charles Hospital Corp

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1164481529

  Hospital

  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Samaritan Medical Services PC 341 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Physician Assistant

State licenses

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

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

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560297600000",
    "number": "1457505083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 BROADWAY",
            "city": "GREENLAWN",
            "state": "NY",
            "postal_code": "117402120",
            "telephone_number": "732-668-4192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 BROADWAY",
            "city": "GREENLAWN",
            "state": "NY",
            "postal_code": "117402120",
            "telephone_number": "732-668-4192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHARD",
        "first_name": "GARY",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-10",
        "last_updated": "2019-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "MP 00002600",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "003223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kip Lord Bodi, MD FACS
• Joyce Bohn
• Patricia A Boller, RN
• Desiree Bollerup, AGPCNP
• Andrea Boltwood, BA, LMT
• Rachel Pearl Bouvin, SLP
• Carrol Brandt, NP
• Bright Horizon Speech Therapy
• Liane Brust
• Kelly Buckley, D.C.

• All providers in Greenlawn, NY
• Medical Physician Assistant in New York

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