Chanel G Bouchereau, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

45636 Issued in MA

Practice address

300 Stafford Street
Suite 113
Springfield, MA 01104-3581

Phone

(413) 737-9746

Fax

(413) 739-1320

NPI assigned

Nov 22, 2006

Last updated

Apr 12, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General SurgeryAlso: Vascular Surgery

Education

University of Hawaii John a. Burns School of Medicine, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Riverbend Medical Group IncGroup PAC ID 5698064343, 227 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Medical Ctr Hospital, Springfield, MA, CCN 220066

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cbouchereau2388053@direct.trinity-health.org

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.

• Riverbend Medical Group, Inc.

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Springfield, MA
  • NPI 1841651197

  Surgery

  Medicare reassignment Care Compare group NPD
• Riverbend Medical Group, Inc

  dba Trinity Health Of New England Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Springfield, MA
  • NPI 1265023154
  NPD
• Mercy Inpatient Medical Associates Inc.

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Springfield, MA
  • NPI 1407845282

  Surgery

  NPD (past)
• Mwa,PC

  dba RiverBend Medical Group

  • Internal Medicine Physician
  • Chicopee, MA
  • NPI 1609821990

  Surgery

  NPD (past)

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

• The Mercy Hospital Inc

  dba Mercy Medical Center

  • General Acute Care Hospital
  • Springfield, MA
  • NPI 1043204316
  Care Compare affiliation
• The Mercy Hospital Inc

  dba Mercy Rehabilitation Hospital

  • Rehabilitation Hospital Unit
  • Springfield, MA
  • NPI 1750360798
  Care Compare affiliation

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271030400000",
    "number": "1598830606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 STAFFORD STREET",
            "address_2": "SUITE 113",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011043581",
            "telephone_number": "413-737-9746",
            "fax_number": "413-739-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 STAFFORD STREET",
            "address_2": "SUITE 113",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011043581",
            "telephone_number": "413-737-9746",
            "fax_number": "413-739-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHEREAU",
        "first_name": "CHANEL",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2010-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "45636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HNE",
            "identifier": "10754",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0166014",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "N51761",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Bott, M.S. C.R.C.
• Carol Boucek
• Michelle Ann Bouchard
• Marcil Boucher
• Sarah Boucher
• Samantha Boudah, MSW
• Abdallah Bouhouari
• David Boulais
• Jeannine Boulay-Buddenhagen, LSWA
• Gail Bourassa

• Surgery Physician in Springfield, MA
• Providers in Springfield, MA by specialty
• Surgery Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2010; 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.