NPIMap

Individual provider Active NPI

Marc Kamel Boustany, MD

  • Surgery Physician
  • Chesapeake, VA
National Provider Identifier
1750386041
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0101221457 Issued in VA
Practice address
725 Volvo Pkwy Ste 210
Chesapeake, VA 23320-1621
Phone
(757) 261-5000
Fax
(757) 962-5610
NPI assigned
Jun 15, 2005
Last updated
Feb 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 0101221457 VA
Surgery Physician 208600000X 0101221457 VA Primary

Addresses

Primary practice location

725 Volvo Pkwy Ste 210
Chesapeake, VA 23320-1621

Mailing address

725 Volvo Pkwy Ste 210
Chesapeake, VA 23320-1621
Phone (757) 261-5000

Other identifiers 1

IdentifierTypeStateIssuer
007309996MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20070614000309 VA Practitioner - General Surgery 2365540309 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Washington University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

213 River Walk Pkwy
Chesapeake, VA 23320-6893
Phone (757) 983-1765

6251 E Virginia Beach Blvd
Norfolk, VA 23502-2824

830 Kempsville Rd
2B223
Norfolk, VA 23502-3920
Phone (757) 261-8860

850 Kempsville Rd
Norfolk, VA 23502-3920

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)27
Mastectomy1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101221457VAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group CurrentSince Jun 1, 2007 Accepting new patients
Vascular & Transplant Specialists PC Past Accepting new patients

Locations

725 Volvo Pkwy
Ste 210
Chesapeake, VA 23320
Phone (757) 252-4130

6160 Kempsville Cir
Ste 101B
Norfolk, VA 23502
Phone (757) 461-2098

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

880 Kempsville Rd
Ste 1000
Norfolk, VA 23502
Phone (757) 261-5000

Interoperability endpoints

  • Direct secure messaging: mboustany22609@direct.sentara.net

Organizations & group practices 2

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 7

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": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1750386041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 VOLVO PKWY STE 210",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233201621",
            "telephone_number": "757-261-5000",
            "fax_number": "757-962-5610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 VOLVO PKWY STE 210",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233201621",
            "telephone_number": "757-261-5000",
            "fax_number": "757-962-5610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSTANY",
        "first_name": "MARC",
        "middle_name": "KAMEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101221457",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101221457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007309996",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.