Active NPI
Corey Craig Bousquet, PA-C
- Physician Assistant
- Fairfield, CT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2478
- Practice address
- 1918 Black Rock Tpke
Fairfield, CT 06825-3543 - Phone
- (203) 583-8400
- NPI assigned
- May 17, 2006
- Last updated
- Jan 25, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9102466 | FL | |
| Physician Assistant | 363A00000X | 2478 | CT | Primary |
Addresses
Primary practice location
1918 Black Rock Tpke
Fairfield, CT 06825-3543
Mailing address
45 Maler Ave
Shelton, CT 06484-5925
Phone (305) 528-9800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 292171500 | Medicaid | FL | |
| 291035 | Other | FL | AMERIGROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL, CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
100 Mill Plain Rd
Danbury, CT 06811-5178
Phone (203) 826-2140
1030 Boulevard
West Hartford, CT 06119-1801
Phone (860) 986-6440
135 E Main St
New Britain, CT 06051-1914
Phone (860) 357-6899
161 Boston Ave
Bridgeport, CT 06610-1662
Phone (203) 333-4400
1918 Black Rock Tpke
Fairfield, CT 06825-3543
Phone (203) 583-8400
2 Main St
Danbury, CT 06810-8047
Phone (203) 826-2140
365 Queen St
Southington, CT 06489-1884
Phone (860) 863-5835
389 Bridgeport Ave
Shelton, CT 06484-5303
Phone (203) 567-4171
396 Cromwell Ave
Rocky Hill, CT 06067-1828
Phone (860) 372-4990
4200 Main St
Bridgeport, CT 06606-2303
Phone (203) 916-5151
527 Elm St
New Haven, CT 06511-4549
Phone (203) 675-1345
57 Monroe Tpke
Trumbull, CT 06611-1315
Phone (203) 675-1345
Merit-based Incentive Payment System (MIPS)
- Final score
- 77.63 of 100
- Quality
- 62.23
- Improvement activities
- 40
- Cost
- 81.29
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2478 | CT | MD | Physician Assistant |
| PA9102466 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Afc Physicians of Connecticut, PC | Current | Accepting new patients | |
| Afc Physicians of Connecticut, PC | Current | Accepting new patients | |
| Cape Coral Emergency Physicians | Past | Accepting new patients | |
| All X Ray Diagnostic Services Corp | Physician Assistant | Past | Accepting new patients |
Locations
2 Main St
Danbury, CT 06810
Phone (203) 826-2140
Organizations & group practices 17
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.
-
- Urgent Care Clinic/Center
- Danbury, CT
- NPI 1003152984
-
- Urgent Care Clinic/Center
- Bridgeport, CT
- NPI 1487087250
-
- Urgent Care Clinic/Center
- Avon, CT
- NPI 1093239683
-
- Emergency Medicine Physician
- Meriden, CT
- NPI 1114482882
-
- Emergency Medicine Physician
- Putnam, CT
- NPI 1447231865
-
- Emergency Medicine Physician
- Willimantic, CT
- NPI 1982889598
-
- Emergency Medicine Physician
- Cape Coral, FL
- NPI 1376611962
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706140800000",
"number": "1598717571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 MALER AVE",
"city": "SHELTON",
"state": "CT",
"postal_code": "064845925",
"telephone_number": "305-528-9800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1918 BLACK ROCK TPKE",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "068253543",
"telephone_number": "203-583-8400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUSQUET",
"first_name": "COREY",
"middle_name": "CRAIG",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2024-01-25",
"certification_date": "2024-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9102466",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CT",
"license": "2478",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "292171500",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "291035",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; 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.