NPIMap

Organization Active NPI

Charles a Boucher MD PC

  • Cardiovascular Disease Physician
  • Boston, MA
National Provider Identifier
1679771646
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
36588 Issued in MA
Legal business name
CHARLES A BOUCHER MD PC
Practice address
8 Hawthorne PL
Suite 110
Boston, MA 02114-2335
Phone
(617) 726-8511
Fax
(617) 742-8446
NPI assigned
Jul 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Authorized official

Name
Dr. Charles Allen Boucher, M.D.NPI 1013986801
Title
President
Phone
(617) 726-8511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 36588 MA
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X 36588 MA Primary

Addresses

Primary practice location

8 Hawthorne PL
Suite 110
Boston, MA 02114-2335

Mailing address

PO Box 51512
Boston, MA 02205-1512
Phone (617) 726-8511

Other identifiers 3

IdentifierTypeStateIssuer
705823OtherMATUFTS HEALTH PLAN
9738193MedicaidMA
M13371OtherMABLUE CROSS BLUE SHIELD OF

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1679771646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51512",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022051512",
            "telephone_number": "617-726-8511",
            "fax_number": "617-742-8446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 HAWTHORNE PL",
            "address_2": "SUITE 110",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142335",
            "telephone_number": "617-726-8511",
            "fax_number": "617-742-8446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES A BOUCHER MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-726-8511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "36588",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "36588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "705823",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9738193",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF",
            "identifier": "M13371",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.