Kelly Boucher, O.D

Primary specialty

OptometristTaxonomy code 152W00000X

License

2802 Issued in OK

Practice address

4913 W Reno Ave
Oklahoma City, OK 73127-6339

Phone

(405) 948-4900

Fax

(405) 948-4933

NPI assigned

Jul 25, 2014

Last updated

Jan 11, 2021By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, OK2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Indiana University - School of Optometry, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lawton Indian HospitalGroup PAC ID 6406800234, 126 clinicians

Central Oklahoma American Indian Health Council, Inc.Group PAC ID 3476617374, 60 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lawton Indian Hospital Hospital, Lawton, OK, CCN 370170

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/

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.

• Central Oklahoma American Indian Health Council, Inc.

  dba Oklahoma City Indian Clinic

  • Federally Qualified Health Center (FQHC)
  • Oklahoma City, OK
  • NPI 1407969728

  TX

  Medicare reassignment Care Compare group NPD
• Lawton Indian Hospital

  • General Acute Care Hospital
  • Lawton, OK
  • NPI 1760489223

  TX

  Medicare reassignment Care Compare group NPD
• Choctaw Nation of Oklahoma

  dba Choctaw Nation Health Care

  • Rural Acute Care Hospital
  • Talihina, OK
  • NPI 1659347623

  TX

  Medicare reassignment NPD
• Northeastern State University College of Optometry

  • Optometrist
  • Tahlequah, OK
  • NPI 1437106333
  Medicare reassignment NPD
• Choctaw Nation of Oklahoma

  dba Choctaw Nation Health Clinic - Broken Bow

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Broken Bow, OK
  • NPI 1447143532
  NPD
• Choctaw Nation of Oklahoma

  dba Choctaw Nation Health Care Clinic-Poteau

  • Primary Care Clinic/Center
  • Poteau, OK
  • NPI 1710953799
  NPD
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Tahlequah, OK
  • NPI 1093722324
  NPD (past)

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

• Anadarko Indian Health Center

  • Federal Public Health Clinic/Center
  • Anadarko, OK
  • NPI 1881637403

  Hospital

  Care Compare affiliation
• Carnegie Indian Health Center

  • Federal Public Health Clinic/Center
  • Carnegie, OK
  • NPI 1457459158

  Hospital

  Care Compare affiliation
• Clinton Indian Health Center

  • Federal Public Health Clinic/Center
  • Clinton, OK
  • NPI 1205923448

  Hospital

  Care Compare affiliation
• El Reno Indian Health Center

  • Public Health or Welfare Agency
  • El Reno, OK
  • NPI 1386725604

  Hospital

  Care Compare affiliation
• Lawton Indian Hospital

  • General Acute Care Hospital
  • Lawton, OK
  • NPI 1760489223
  Care Compare affiliation
• Watonga Indian Health Center

  • Public Health or Welfare Agency
  • Watonga, OK
  • NPI 1558458794

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1528476207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4913 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276339",
            "telephone_number": "405-948-4900",
            "fax_number": "405-948-4933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4913 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276339",
            "telephone_number": "405-948-4900",
            "fax_number": "405-948-4933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-25",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathy Bottroff, LPC
• Amy Nichol Bouchell, ARNP
• Abby Bouchelle
• Dania Boucher
• Jeremy Michael Boucher, MD
• Peppi Boudreau
• Shawn F Boudreau
• Rachel Kay Boughan, RN
• Ashley Bouknight
• John Douglas Boulanger

• Optometrist in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.