Jeffery Bouma, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Wpafb, OH
NPI 1497557607 · NPPES record last updated Feb 5, 2026
Key facts
- NPI
- 1497557607
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 4881 Sugar Maple Dr
Wpafb, OH 45433-5529 - Phone
- (937) 257-9926
- NPI assigned
- Mar 26, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250519001166 | OH | Order and Referring Only - Internal Medicine |
8022536580 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
4881 Sugar Maple Dr
Wpafb, OH 45433-5529
Mailing address
4881 Sugar Maple Dr
Wpafb, OH 45433-5529
Phone (937) 257-9926
Other providers in Wpafb, OH
- Joel Tyler Basenback
- Elizabeth A. Batchelor
- Brian Christopher Bentele
- Robert Keith Bogart
- Vincent Anthony Bonanno
- Vera Lavonne Bowie
- Robert Allan Briggs
- Linda Susan Broeckl
- Christopher M Brown
- Colin Matthew Burchfield
All providers in Wpafb, OH · Student in an Organized Health Care Education/Training Program in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.