Dimitrios P Bousounis, M.D.

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

License

27172 Issued in WI

Practice address

200 W. Silver Spring Drive
# 255
Glendale, WI 53217

Phone

(414) 964-8450

Fax

(414) 964-8451

NPI assigned

Oct 2, 2006

Last updated

Oct 17, 2007By 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 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

State licenses

Practice roles

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.

• Dimitrios P Bousounis MD

  • Medical Specialty Clinic/Center
  • Glendale, WI
  • NPI 1073666269
  NPD (past) Authorized official

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1861585408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W. SILVER SPRING DRIVE",
            "address_2": "# 255",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "53217",
            "telephone_number": "414-964-8450",
            "fax_number": "414-964-8451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W. SILVER SPRING DRIVE",
            "address_2": "# 255",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "53217",
            "telephone_number": "414-964-8450",
            "fax_number": "414-964-8451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSOUNIS",
        "first_name": "DIMITRIOS",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "27172",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "WI",
            "license": "27172",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "WI",
            "license": "27172",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30679100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Bolander, MS, CCC-SLP
• Bonnie J Behee-Semler PHD SC
• Heidi H Borca, M.D.
• Christopher John Borden, MA, LPC, CSAC, NCC
• Robert Anthony Bottalla Jr.
• Earl E. Bracy, PSYD
• Margaret Mathews Brauer, PT
• Corliss Ann Breen
• Mary T Breger, MD
• Tracy Lynn Bretl, D.O.

• Neurology with Special Qualifications in Child Neurology Physician in Glendale, WI
• Providers in Glendale, WI by specialty
• Neurology with Special Qualifications in Child Neurology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.