Mark Ricard Boudreau Jr., DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

11273 Issued in GA

Practice address

304 Shorter Ave NW Ste 105
Rome, GA 30165-4256

Phone

(706) 236-4880

NPI assigned

Apr 10, 2019

Last updated

May 26, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mboudreau433959@carolinashealthcaresystem.direct-ci.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.

• Floyd Healthcare Management Inc

  dba Atrium Health Floyd Primary Care

  • Family Medicine Physician
  • Rome, GA
  • NPI 1689610149
  Medicare reassignment NPD
• Floyd Healthcare Management Inc

  dba Atrium Health Floyd Specialty Pharmacy

  • Specialty Pharmacy
  • Rome, GA
  • NPI 1548056468
  NPD
• Health Services of Central Georgia, Inc

  dba Atrium Health Navicent Medical Group

  • Multi-Specialty Clinic/Center
  • Macon, GA
  • NPI 1184679482

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1659834323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E 2ND AVE STE 103",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301613210",
            "telephone_number": "706-509-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 SHORTER AVE NW STE 105",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654256",
            "telephone_number": "706-236-4880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2370 Rockmart Hwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Cedartown",
            "state": "GA",
            "postal_code": "301256029",
            "country_code": "US",
            "telephone_number": "770-748-7818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "MARK",
        "middle_name": "RICARD",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-10",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "11273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mboudreau433959@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "N",
            "address_1": "304 Shorter Ave NW Ste 105",
            "city": "Rome",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301654256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Marius Florin Bodiu, DPT
• Michael Ann Booth, PA
• Marc Borchardt, CRNA
• Joseph John Borrillo, PA
• Jenna Bosarge, SLP
• Boundless Therapy Services, LLC
• Amine Bourbia, MD
• Alan Lee Bowen, MD
• David Bowen, DDS
• Scott G Bowerman, M.D.

• Pediatrics Physician in Rome, GA
• Providers in Rome, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.