Brian Bouch, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G35969 Issued in CA

Practice address

1410 Skillman LN
Petaluma, CA 94952-1249

Phone

(707) 696-7427

Fax

(707) 615-5775

NPI assigned

Sep 27, 2006

Last updated

Jul 15, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Bouch Medical Corporation

  dba Hill Park Medical Center

  • General Practice Physician
  • Sebastopol, CA
  • NPI 1720467962
  NPD (past)
• Hill Park Integrative Medical Center

  dba Hill Park Medical Center

  • General Practice Physician
  • Sebastopol, CA
  • NPI 1952755415
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1750472213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 SKILLMAN LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949521249",
            "telephone_number": "707-765-0259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 SKILLMAN LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949521249",
            "telephone_number": "707-696-7427",
            "fax_number": "707-615-5775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCH",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G35969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Elizabeth Bordessa, RDN, LD
• Magin Delgado Borrajo, PH.D., MFT
• Louise M Bortolotti
• Marques Joseph Bostic, O.D
• Hope Lovena Bottini
• Larry Howard Lee Bowen, ARRT(R) EMT(B)
• Nicole Bowman
• Rob Bowman, LMFT
• Boyd Recovery LLC
• Alexander Christopher Boyer

• Family Medicine Physician in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.