Active NPI
Timothy Peter Boufford, M.D.
- Internal Medicine Physician
- Clinton TWP, MI
National Provider Identifier
1811991177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301062476
- Practice address
- 15855 19 Mile Rd
Henry Ford Macomb
Clinton TWP, MI 48038-3504 - Phone
- (734) 464-0887
- Fax
- (734) 402-0254
- NPI assigned
- Jun 2, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301062476 | MI | Primary |
| Hospitalist Physician | 208M00000X | 4301062476 | MI |
Addresses
Primary practice location
15855 19 Mile Rd
Henry Ford Macomb
Clinton TWP, MI 48038-3504
Mailing address
36115 Schoolcraft Rd
Livonia, MI 48150-1216
Phone (734) 464-0887
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 70-0-F32947-0 | Other | MI | BCBS CPIN # |
| 4846333 | Medicaid | MI | |
| 1811991177 | Other | MI | NPI # |
| TB062476 | Other | MI | BCBSM |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301062476 | MI | MD | Hospitalist Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407456000000",
"number": "1811991177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36115 SCHOOLCRAFT RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481501216",
"telephone_number": "734-464-0887",
"fax_number": "734-402-0254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15855 19 MILE RD",
"address_2": "HENRY FORD MACOMB",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480383504",
"telephone_number": "734-464-0887",
"fax_number": "734-402-0254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUFFORD",
"first_name": "TIMOTHY",
"middle_name": "PETER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-02",
"last_updated": "2014-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301062476",
"primary": true
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "MI",
"license": "4301062476",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS CPIN #",
"identifier": "70-0-F32947-0",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4846333",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI #",
"identifier": "1811991177",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "TB062476",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clinton TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.