Individual provider Active NPI

Elise Bouchard, FNP-C

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1801510912
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
350065 Issued in NY
Practice address
1000 10TH Ave
New York, NY 10019-1147
Phone
(315) 727-3051
NPI assigned
Oct 3, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 350065 NY Primary

Addresses

Primary practice location

1000 10TH Ave
New York, NY 10019-1147

Mailing address

2074 Frdrck DGLS Blvd Apt 2C
New York, NY 10026-3299
Phone (315) 727-3051

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230208001974 NY Practitioner - Nurse Practitioner 0648642272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

622 W 168TH St
New York, NY 10032-3720
Phone (212) 305-9876

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
350065NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Nov 18, 2022 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Nov 18, 2022 Accepting new patients
Trustees of Columbia University in the City of New York Current Accepting new patients
Neurosurgical Associates, P.C. PastSince Jan 1, 1990 Accepting new patients
Trustees of Columbia University in the Department of Otolaryngology Past Accepting new patients

Locations

12 Studio Arc
Bronxville, NY 10708
Phone (914) 202-0135

55 Palmer Ave
Bronxville, NY 10708
Phone (914) 787-3136

710 W 168th St
Ste 425
New York, NY 10032
Phone (212) 305-1090

177 Fort Washington Ave
New York, NY 10032
Phone (212) 305-3090

5141 Broadway
New York, NY 10034
Phone (212) 932-4000

710 W 168th St
New York, NY 10032
Phone (212) 305-0217

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

3959 Broadway
New York, NY 10032
Phone (212) 304-7297

155 White Plains Rd
Tarrytown, NY 10591
Phone (914) 332-7571

Networks

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

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1801510912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2074 FRDRCK DGLS BLVD APT 2C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100263299",
            "telephone_number": "315-727-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191147",
            "telephone_number": "315-727-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHARD",
        "first_name": "ELISE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "350065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.