Individual provider Active NPI

Bernard Roger Boulanger, M.D.

  • Surgical Critical Care Physician
  • Lexington, KY
National Provider Identifier
1508815796
Registry record updated Jan 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
34259 Issued in KY
Practice address
740 South Limestone
Lexington, KY 40536-0001
Phone
(859) 257-3253
NPI assigned
May 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 34259 KY Primary
Trauma Surgery Physician 2086S0127X 34259 KY

Addresses

Primary practice location

740 South Limestone
Lexington, KY 40536-0001

Mailing address

2333 Alumni Park PLZ
Suite 200
Lexington, KY 40517-4012
Phone (859) 218-5677

Other identifiers 1

IdentifierTypeStateIssuer
64342959MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kentucky Medical Services Foundation, Inc Current Accepting new patients

Locations

2333 Alumni Park Plz
Ste 200
Lexington, KY 40517

150 N Eagle Creek Dr
Lexington, KY 40509
Phone (859) 267-9773

2400 Greatstone Pt
Lexington, KY 40504
Phone (859) 257-9800

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357171200000",
    "number": "1508815796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 ALUMNI PARK PLZ",
            "address_2": "SUITE 200",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405174012",
            "telephone_number": "859-218-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 SOUTH LIMESTONE",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360001",
            "telephone_number": "859-257-3253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULANGER",
        "first_name": "BERNARD",
        "middle_name": "ROGER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2013-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "KY",
            "license": "34259",
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "KY",
            "license": "34259",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64342959",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.