Mary Ellen Boudreau, NP (AGPCNP-BC)
Individual provider Active NPI Primary Care Nurse Practitioner · Mason, MI
NPI 1730523598 · NPPES record last updated Jan 29, 2014
Key facts
- NPI
- 1730523598
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 4704265711 (MI)
- Practice address
- 790 E Columbia St
Mason, MI 48854-1387 - Phone
- (517) 244-0120
- NPI assigned
- Apr 24, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 25
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Edward W Sparrow Hospital Association
Central Michigan District Health Department
Practice addresses (Care Compare)
1200 E Michigan Ave
Suite 500
Lansing, MI 48912-1864
Phone (517) 484-4033
1200 E Michigan Ave
Suite 500
Lansing, MI 48912-1899
4489 M
Suite 61
Standish, MI 48658-9273
Phone (989) 846-6541
Hospital & facility affiliations
- Sparrow Home Care
- Elara Caring
- Edward W Sparrow Hospital
- University of Michigan Health- Sparrow Clinton
- McLaren Greater Lansing
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140228001793 | MI | Practitioner - Nurse Practitioner | 4183854672 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801065539 | MI | MD | Clinical Social Worker |
| 4704265711 | MI | MD | Community Health Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Michigan District Health Department | Current |
Accepting new patients | |
| Edward W Sparrow Hospital Association | Nurse Practitioner | Current |
Accepting new patients |
| Edward W. Sparrow Hospital Association | Past | Accepting new patients | |
| Sunshine Family Care Clinic, PLLC | Past |
Accepting new patients | |
| Msu Health Care Inc | Past | Accepting new patients | |
| Sunshine Family Cares, Inc. | Past |
Accepting new patients |
Locations
8175 Reliable Pkwy
Chicago, IL 60686
1200 E Michigan Ave
Ste 500
Lansing, MI 48912
Phone (517) 364-5123
2012 E Preston St
Mt Pleasant, MI 48858
Phone (989) 773-5921
4489 M 61
Standish, MI 48658
Phone (989) 846-2600
Interoperability endpoints
- mary.boudreau@237821350117380.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 4704265711 | MI | Yes |
| Clinical Social Worker | 1041C0700X | 6801065539 | MI | |
| Community Health Registered Nurse | 163WC1500X | 4704265711 | MI |
Addresses
Primary practice location
790 E Columbia St
Mason, MI 48854-1387
Mailing address
790 E Columbia St
Mason, MI 48854-1387
Phone (517) 244-0120
Other providers in Mason, MI
- Jacie J Behm
- Bennett Optometry LLC
- Anja Bode
- Lori Bogard-Cusack
- Jennifer Gay Borges
- Courtney Bowman
- Kara Marie Bowman
- Kristine Brady
- Branch Counseling LLC
- Vanity Bronson
All providers in Mason, MI · Primary Care Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.