Marc Anthony Bouchard, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

OP60942131 Issued in WA

Practice address

1615 Delaware St
Longview, WA 98632-2367

Phone

(360) 636-4836

Fax

(360) 636-6792

NPI assigned

Jun 20, 2011

Last updated

May 29, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, DC, NC, TX4 enrollments

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 4

Specialty

Psychiatry

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Goyal Medpsych IncGroup PAC ID 3375978984, 25 clinicians

Providence Health and Services WashingtonGroup PAC ID 6709782600, 480 clinicians

The Moses H Cone Memorial Hospital Operating CorporationGroup PAC ID 6204744600, 724 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mbouchard660091@direct.peacehealth.org
• Direct secure messaging: mbouchard753922@direct.conehealth.com

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.

• Providence Health & Services Washington

  dba Providence Medical Group SouthWest Washington

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1174744304
  Medicare reassignment Care Compare group NPD
• Goyal Medpsych Inc

  • Psychiatry Physician
  • North Bethesda, MD
  • NPI 1083260756

  DC

  Medicare reassignment Care Compare group NPD
• The Moses H. Cone Memorial Hospital Operating Corporation

  dba Cone Health Sickle Cell Center

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1013265909
  Medicare reassignment Care Compare group NPD
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Olympia, WA
  • NPI 1619176997
  Medicare reassignment NPD
• Alamance Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Burlington, NC
  • NPI 1326010273
  Medicare reassignment NPD
• Brightside Medical, P.C.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1801355482

  TX

  Medicare reassignment NPD
• Brightside Medical of New Jersey, P.C.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1811524754

  NC

  Medicare reassignment
• Providence Health & Services Washington

  dba Providence Community Care Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Olympia, WA
  • NPI 1023550050
  NPD
• Alamance Regional Medical Center, Inc

  dba ARMC Health Care Employee Pharmacy

  • Pharmacy
  • Burlington, NC
  • NPI 1851681993
  NPD
• Peacehealth

  dba St. John Medical Center

  • General Acute Care Hospital
  • Longview, WA
  • NPI 1073510277
  NPD (past)
• The Moses H. Cone Memorial Hospital Operating Corporation

  • Psychiatric Hospital Unit
  • Greensboro, NC
  • NPI 1295848562
  NPD (past)

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1750677605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 GALLOWS RD STE D",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823962",
            "telephone_number": "603-858-0047",
            "fax_number": "331-204-0820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-636-4836",
            "fax_number": "360-636-6792"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2110 Gallows Rd Ste D",
            "address_purpose": "LOCATION",
            "city": "Vienna",
            "state": "VA",
            "postal_code": "221823962",
            "country_code": "US",
            "telephone_number": "703-592-4600",
            "fax_number": "331-204-0820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUCHARD",
        "first_name": "MARC",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-20",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0102203346",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "OP60942131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean Booi
• Marta Elizabeth Bordeaux
• Lauren Borden
• Tobin Andrew Boslaugh, PHARMD
• Jacob D Boston, CRNA
• John William Boucher, M.D.
• Ashley Bowers, SUDP
• Annie O Bowlby, LMP
• Daren D Bowlby, D.C.
• Daniel Bowman, D.P.T.

• Psychiatry Physician in Longview, WA
• Providers in Longview, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.