Individual provider Active NPI

John G Boulet, MD

  • Emergency Medicine Physician
  • Huntsville, AL
National Provider Identifier
1669436796
Registry record updated Feb 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD.27888 Issued in AL
Practice address
101 Sivley Rd SW
Em Dept
Huntsville, AL 35801-4421
Phone
(256) 265-9905
Fax
(256) 265-9910
NPI assigned
Apr 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD.27888 AL Primary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X G3171 TX

Addresses

Primary practice location

101 Sivley Rd SW
Em Dept
Huntsville, AL 35801-4421

Mailing address

PO Box 11407
Drawer 0314
Birmingham, AL 35246-0314
Phone (405) 751-4664

Other identifiers 4

IdentifierTypeStateIssuer
051558705MedicaidAL
4134776OtherALAETNA
009943232MedicaidAL
051004447OtherALBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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

Enrollment IDStateProvider typePAC IDDetails
I20070518000553 AL Practitioner - Emergency Medicine 2769589159 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD.27888ALMDEmergency Medicine Physician
G3171TXMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Group Emergency Medicine CurrentSince Jun 22, 2008 Accepting new patients

Locations

101 Sivley Rd SW
Huntsville, AL 35801
Phone (256) 265-9870

245 Governors Dr SE
Huntsville, AL 35801
Phone (256) 265-7673

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265673600000",
    "number": "1669436796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "address_2": "DRAWER 0314",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352460314",
            "telephone_number": "405-751-4664",
            "fax_number": "405-749-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SIVLEY RD SW",
            "address_2": "EM DEPT",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014421",
            "telephone_number": "256-265-9905",
            "fax_number": "256-265-9910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULET",
        "first_name": "JOHN",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2010-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "MD.27888",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "TX",
            "license": "G3171",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051558705",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4134776",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009943232",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051004447",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

Verify at the official NPI Registry.