Active NPI
Jamie David Boudreau, ATC
- Athletic Trainer
- Derry, NH
National Provider Identifier
1780146688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0072
- Practice address
- 19 N Main St
Derry, NH 03038-1208 - Phone
- (603) 437-5200
- Fax
- (603) 437-5244
- NPI assigned
- Apr 1, 2019
- Last updated
- Apr 1, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0072 | NH | Primary |
Addresses
Primary practice location
19 N Main St
Derry, NH 03038-1208
Mailing address
114 Helen Dearborn Rd
Weare, NH 03281-5816
Phone (603) 437-5200
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0072 | NH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554076800000",
"number": "1780146688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 HELEN DEARBORN RD",
"city": "WEARE",
"state": "NH",
"postal_code": "032815816",
"telephone_number": "603-437-5200",
"fax_number": "603-437-5244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 N MAIN ST",
"city": "DERRY",
"state": "NH",
"postal_code": "030381208",
"telephone_number": "603-437-5200",
"fax_number": "603-437-5244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDREAU",
"first_name": "JAMIE",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-04-01",
"last_updated": "2019-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NH",
"license": "0072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Derry, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.