Gertha Boucicault

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F345182-01 Issued in NY

Practice address

21211 102ND Ave
Apt. C4
Queens Village, NY 11429-1106

Phone

(718) 468-8298

NPI assigned

Sep 22, 2010

Last updated

Jun 30, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gertha.boucicault.1@24989.direct.athenahealth.com

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.

• Amb Medical Services, P.C.

  • Family Medicine Physician
  • Hauppauge, NY
  • NPI 1568534766
  Medicare reassignment NPD
• New Season Wellness Family Health NP PLLC

  • Clinic/Center
  • Albany, NY
  • NPI 1770309734
  NPD Authorized official

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1619285814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21211 102ND AVE",
            "address_2": "APT. C4",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114291106",
            "telephone_number": "718-468-8298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21211 102ND AVE",
            "address_2": "APT. C4",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114291106",
            "telephone_number": "718-468-8298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCICAULT",
        "first_name": "GERTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-22",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F345182-01",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "573530",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Bonsignore, LCSW
• Blanca L Borboa, D.D.S.
• Shavon Boston
• Margo Brenda Bou8Cher, LPN
• Delourdes Bouchereau, LPN
• Jean Marc R Boucicault
• Jean-Robert Boursiquot, M.D.
• Sarah Bowe
• Shanice Bowen-Murray
• Annalisa Boyd, LPN

• Family Nurse Practitioner in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.