NPIMap

Individual provider Active NPI

Gary F Bouloux, MD, DDS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Atlanta, GA
National Provider Identifier
1750335733
Registry record updated Nov 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
057350 Issued in GA
Practice address
1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone
(404) 778-5000
NPI assigned
May 22, 2006
Last updated
Nov 14, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 057350 GA Primary

Addresses

Primary practice location

1365 Clifton Rd NE
Atlanta, GA 30322-1013

Mailing address

1365B Clifton Rd NE
Suite 2300
Atlanta, GA 30322-1013
Phone (404) 778-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060711000340 GA Practitioner - Maxillofacial Surgery 5294748455 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial Surgery
Education
Emory University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians
Emory Medical Care Foundation IncGroup PAC ID 4981501814, 1,003 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

2201 Henderson Mill Rd NE
Atlanta, GA 30345-2711

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3031
Phone (404) 616-1000

Correll Pavilion
80 Gilmer St.SE
Atlanta, GA 30303-9998
Phone (404) 616-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.24 of 100Reported as group
Quality
73.72
Promoting interoperability
100
Improvement activities
40
Cost
75.22

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
057350GAMDOral & Maxillofacial Surgery (D.M.D.)

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation CurrentSince Aug 1, 2006 Accepting new patients
The Emory Clinic Inc CurrentSince Mar 1, 2010 Accepting new patients
Emory Medical Care Foundation Inc Current Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Aug 1, 2006 Accepting new patients
Emory Health Care Past Accepting new patients
Emory Specialty Associates, LLC Past Accepting new patients
The Emory Clinic Pediatric Providers Past Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

1365 Clifton Rd NE
Ste B2300
Atlanta, GA 30322

1365 Clifton Rd NE
Ste 2300
Atlanta, GA 30322
Phone (404) 778-3387

101 W Ponce de Leon Ave
Ste 300
Decatur, GA 30030
Phone (404) 778-4889

Interoperability endpoints

  • Direct secure messaging: gbouloux21698@direct.emory.org
  • Direct secure messaging: gbouloux10677@choa.gadirect.net

Organizations & group practices 7

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

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": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415923200000",
    "number": "1750335733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365B CLIFTON RD NE",
            "address_2": "SUITE 2300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221013",
            "telephone_number": "404-778-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221013",
            "telephone_number": "404-778-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULOUX",
        "first_name": "GARY",
        "middle_name": "F",
        "credential": "MD, DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2014-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "GA",
            "license": "057350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.