Tyson Jude Boudreaux, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

258252 Issued in NY

Practice address

600 E 125TH St
Manhattan Psychiatric Center, Dunlap 5B
New York, NY 10035-6000

Phone

(646) 672-6052

NPI assigned

Aug 22, 2008

Last updated

Mar 5, 2013By 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 NY

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

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: tyson.boudreaux@uram.eclinicaldirectplus.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.

• Upper Room AIDS Ministry, Inc. Adult Day Health Care Center.

  • Clinic/Center
  • New York, NY
  • NPI 1417986340

  Psychiatry

  Medicare reassignment NPD
• Shlomit Levy

  • Preferred Provider Organization
  • New York, NY
  • NPI 1407219447
  NPD (past)

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362441600000",
    "number": "1780831669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E 125TH ST",
            "address_2": "MANHATTAN PSYCHIATRIC CENTER, DUNLAP 5B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100356000",
            "telephone_number": "646-672-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E 125TH ST",
            "address_2": "MANHATTAN PSYCHIATRIC CENTER, DUNLAP 5B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100356000",
            "telephone_number": "646-672-6052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "TYSON",
        "middle_name": "JUDE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-22",
        "last_updated": "2013-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "258252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridgette Boucher, LCSW, MS
• Nathan A Boucher, PA
• Thomas Boucher, MD
• Brianna Bouchez, FNP-C
• Nicole Boucicaut, PA-C
• Dmitri Bougakov, PH.D.
• Mohamed A Bouhara, M.D
• Ismail Bouhout, MD, MSC
• Caroline Emilie Bouillon, PA-C
• Meriem Boukadoum

• Psychiatry Physician in New York, NY
• Providers in New York, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2013; 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.