Active NPI
Floyd Fredick Bouse, DDS
- Dentist
- Fairbanks, AK
National Provider Identifier
1689843252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 404
- Practice address
- 3745 Geist Rd
Fairbanks, AK 99709-3548 - Phone
- (907) 479-2208
- Fax
- (907) 474-8488
- NPI assigned
- Feb 27, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 404 | AK | Primary |
Addresses
Primary practice location
3745 Geist Rd
Fairbanks, AK 99709-3548
Mailing address
3745 Geist Rd
Fairbanks, AK 99709-3548
Phone (907) 479-2208
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005931238 | Other | AK | AETNA |
| 920074602F001 | Other | AK | BLUE CROSS FEDERAL |
| 93422077280001 | Other | AK | PREMERA BLUE CROSS MEDICA |
| 00008699 | Other | AK | BANNER HEATH |
| 825962 | Other | AK | UNITED CONCORDIA |
| 207728100000 | Other | AK | PREMERA BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 404 | AK | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204070400000",
"number": "1689843252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3745 GEIST RD",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093548",
"telephone_number": "907-479-2208",
"fax_number": "907-474-8488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3745 GEIST RD",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093548",
"telephone_number": "907-479-2208",
"fax_number": "907-474-8488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUSE",
"first_name": "FLOYD",
"middle_name": "FREDICK",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-27",
"last_updated": "2008-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "404",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0005931238",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS FEDERAL",
"identifier": "920074602F001",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS MEDICA",
"identifier": "93422077280001",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BANNER HEATH",
"identifier": "00008699",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "825962",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS",
"identifier": "207728100000",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.