Susan L. Boullioun, M.D., P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

K2312 Issued in TX

Legal business name

SUSAN L. BOULLIOUN, M.D., P.A.

Practice address

113 E. Cedar St.
Seguin, TX 78155-3709

Phone

(830) 303-3500

Fax

(830) 303-9399

NPI assigned

Jan 12, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Susan Lorton Boullioun, M.D.NPI 1528148889

Title

President

Phone

(830) 303-3500

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1838/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan L Boullioun, MD

  • Family Medicine Physician
  • Seguin, TX
  • NPI 1528148889
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1231718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262822400000",
    "number": "1588801609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 E CEDAR ST",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781553709",
            "telephone_number": "830-303-3500",
            "fax_number": "830-303-9399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 E. CEDAR ST.",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781553709",
            "telephone_number": "830-303-3500",
            "fax_number": "830-303-9399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN L. BOULLIOUN, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-12",
        "last_updated": "2010-01-07",
        "status": "A",
        "authorized_official_last_name": "BOULLIOUN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "LORTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "830-303-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K2312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121420704",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121420702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Stewart
• Megan Stivers, DDS
• Rhianna Adele Sturgeon I
• John Suarez, PTA
• Linda Jane Sullivan, D.O.
• Niesha Sutton, LVN
• Jennifer Kaye Swanson, RD
• Pamela A Tackett, DC
• Nicole Janice Talbot, D.O.
• Mark Tamez, RPH

• Family Medicine Physician in Seguin, TX
• Providers in Seguin, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.