Jennifer Brooke Boudreau, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101258315 Issued in VA

Practice address

540 Fort Evans Rd
Suite 204
Leesburg, VA 20176-3379

Phone

(703) 737-3500

Fax

(703) 737-3550

NPI assigned

May 27, 2010

Last updated

Oct 13, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jennifer Brooke White Former name

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Family Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Inova Loudoun Hospital Hospital, Leesburg, VA, CCN 490043

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Vita Family Medicine and Medspa LLC

  • Family Medicine Physician
  • Leesburg, VA
  • NPI 1730532359
  Medicare reassignment NPD Authorized official
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• University Healthcare Physicians, Inc.

  • Family Medicine Physician
  • Martinsburg, WV
  • NPI 1659625739
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Inova Health Care Services

  dba Inova Loudoun Hospital

  • Psychiatric Hospital Unit
  • Leesburg, VA
  • NPI 1285786228
  Care Compare affiliation
• Inova Health Care Services

  dba Inova Loudoun Hospital

  • General Acute Care Hospital
  • Leesburg, VA
  • NPI 1376564302
  Care Compare affiliation

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1811216021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 FORT EVANS RD",
            "address_2": "SUITE 204",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201763379",
            "telephone_number": "703-737-3500",
            "fax_number": "703-737-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 FORT EVANS RD",
            "address_2": "SUITE 204",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201763379",
            "telephone_number": "703-737-3500",
            "fax_number": "703-737-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "JENNIFER",
        "middle_name": "BROOKE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-27",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "25438",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101258315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810026353",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WHITE",
            "middle_name": "BROOKE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Henna Sonali Boolchandani, MD
• Lisa Marie Boris, CRNP
• Nikole Lyn Boshonek, MSN, FNP-BC, DIPACLM
• Elizabeth Ann Bosmajian, PSYD,LPC
• Jaime Bosserman
• Christopher Sullivan Bourke Jr., D.P.M.
• Kathy Lynn Bowen, O.D
• Ashley Lee Bowers, M.A., M.S., QMHP
• David Thomas Boyd, M.D., M.B.A.
• Rebecca Robinson Brabender, M.D.

• Family Medicine Physician in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; 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.