Individual provider Active NPI

Klayme-Shane Boucher, DO

  • Internal Medicine Physician
  • San Antonio, TX
National Provider Identifier
1689317141
Registry record updated Jul 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
V8588 Issued in TX
Practice address
12446 West Ave Ste 200
San Antonio, TX 78216-2530
Phone
(210) 525-1668
NPI assigned
Apr 13, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X V8588 TX
Internal Medicine Physician 207R00000X V8588 TX Primary

Addresses

Primary practice location

12446 West Ave Ste 200
San Antonio, TX 78216-2530

Mailing address

12446 West Ave Ste 200
San Antonio, TX 78216-2530
Phone (210) 525-1668

Other practice location 1

4502 Medical Dr
San Antonio, TX 78229-4402
Phone (210) 358-3555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20250618002410 TX Practitioner - HospitalistPractitioner - Internal Medicine 9638680366 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Complete Care Medical AssociatesGroup PAC ID 5698029882, 39 clinicians
Hospital Medicine Services of TX, PLLCGroup PAC ID 3274998067, 376 clinicians

Practice addresses (Care Compare)

12446 W Ave
Suite 200
San Antonio, TX 78216-2530
Phone (210) 525-1668

1310 McCullough Ave
San Antonio, TX 78212-5601
Phone (210) 757-2200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
V8588TXMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medicine Associates Internal Medicine CurrentSince Jun 12, 2025 Accepting new patients
Complete Care Medical Associates Hospitalist CurrentSince Jul 1, 2025 Accepting new patients
Hospital Medicine Services of TX, PLLC Hospitalist CurrentSince Dec 1, 2025 Accepting new patients
Methodist Healthcare System of San Antonio, LTD., L.L.P. Past Accepting new patients

Locations

12141 Richmond Ave
Houston, TX 77082
Phone (281) 558-3444

11100 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 770-7000

1310 McCullough Ave
San Antonio, TX 78212
Phone (210) 208-2200

12446 West Ave
Ste 200
San Antonio, TX 78216
Phone (210) 690-0230

4502 Medical Dr
San Antonio, TX 78229
Phone (210) 358-3555

903 W Martin St
#492
San Antonio, TX 78207
Phone (210) 358-3441

7700 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 575-5564

12446 West Ave
Ste 256
San Antonio, TX 78216

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752278400000",
    "number": "1689317141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12446 WEST AVE STE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782162530",
            "telephone_number": "210-525-1668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12446 WEST AVE STE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782162530",
            "telephone_number": "210-525-1668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4502 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782294402",
            "country_code": "US",
            "telephone_number": "210-358-3555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUCHER",
        "first_name": "KLAYME-SHANE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-13",
        "last_updated": "2025-07-12",
        "certification_date": "2025-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "V8588",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "V8588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.