Jennifer Nofar Boukouris, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

4301088556 Issued in MI

Practice address

22101 Moross Rd
Department of Emergency Medicine
Detroit, MI 48236-2148

Phone

(313) 343-8797

Fax

(313) 343-7620

NPI assigned

Jun 8, 2007

Last updated

Feb 20, 2008By 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 1

Addresses

Other names 1

• Dr. Jennifer Boukouris Professional name

Medicare fee-for-service enrollment

Enrolled in MI

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

Emergency Medicine

Education

Wayne State University School of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Independent Emergency Physicians PCGroup PAC ID 6709798325, 173 clinicians

Independent Observation Physicians PLLCGroup PAC ID 3577603604, 138 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Providence Hospital, Southfield and Novi Hospital, Southfield, MI, CCN 230019
• Henry Ford Health Warren Hospital Hospital, Warren, MI, CCN 230195

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jboukouris1118315@direct.hfhs.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.

• Independent Emergency Physicians, P.C.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Southfield, MI
  • NPI 1780791343
  Medicare reassignment Care Compare group NPD
• Independent Observation Physicians PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Southfield, MI
  • NPI 1700119500
  Medicare reassignment Care Compare group NPD

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

• Henry Ford Health Macomb Oakland Hospital

  dba St. John Macomb Oakland Hospital-Warren Campus

  • General Acute Care Hospital
  • Warren, MI
  • NPI 1124099858
  Care Compare affiliation
• Henry Ford Health Macomb Oakland Hospital

  dba St John Macomb Oakland - Oakland Center

  • General Acute Care Hospital
  • Madison Heights, MI
  • NPI 1215139233
  Care Compare affiliation
• Henry Ford Health Providence Hospital

  • General Acute Care Hospital
  • Novi, MI
  • NPI 1144210253
  Care Compare affiliation

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203465600000",
    "number": "1659574317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-8797",
            "fax_number": "313-343-7620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-8797",
            "fax_number": "313-343-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOFAR BOUKOURIS",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-08",
        "last_updated": "2008-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301088556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BOUKOURIS",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Patricia Ann Nobra-Zoltowski, CRNA
• Harold Scott Nodler, PT
• Jacque Rene Noe
• Noel Medical Equip Co (Mike Brown & Assoc)
• Noel Upfall D.O. P.C.
• Nola Hope Home Care LLC
• Jeffrey Samuel Nolan, LMSW
• Jemma Joy Nolan, RDH
• Ryan Nolan, MD
• Victoria Violassi Nolan, PA-C

• Emergency Medicine Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.