Active NPI
Michelle Boucher, PA
- Physician Assistant
- Orange, CA
National Provider Identifier
1750337895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA15464
- Practice address
- 200 S Manchester Ave
Suite #300
Orange, CA 92868-3217 - Phone
- (714) 456-3856
- NPI assigned
- May 26, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA15464 | CA | Primary |
Addresses
Primary practice location
200 S Manchester Ave
Suite #300
Orange, CA 92868-3217
Mailing address
200 S Manchester Ave
Suite # 300
Orange, CA 92868-3217
Phone (714) 456-3856
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA15464 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greater Los Angeles Oncology Medical Corporation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Hematology & Oncology Physician
- Los Angeles, CA
- NPI 1295746394
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750337895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 S MANCHESTER AVE",
"address_2": "SUITE # 300",
"city": "ORANGE",
"state": "CA",
"postal_code": "928683217",
"telephone_number": "714-456-3856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S MANCHESTER AVE",
"address_2": "SUITE #300",
"city": "ORANGE",
"state": "CA",
"postal_code": "928683217",
"telephone_number": "714-456-3856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHER",
"first_name": "MICHELLE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA15464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.