Michelle J Bouley, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA4987 Issued in MA

Practice address

1 Orthopedics Dr
2ND Floor
Peabody, MA 01960-1668

Phone

(978) 818-6350

Fax

(978) 854-4811

NPI assigned

Mar 24, 2014

Last updated

Sep 25, 2017By 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 1

Addresses

Other names 1

• Michelle J Gravallese Former name

Medicare fee-for-service enrollment

Enrolled in MA

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

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sports Medicine North Orthopaedic Surgery, Inc.Group PAC ID 0547259095, 87 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Anna Jaques Hospital Hospital, Newburyport, MA, CCN 220029
• Northeast Hospital Corporation Hospital, Beverly, MA, CCN 220033
• Spaulding Rehabilitation Hospital Inpatient rehabilitation facility, Charlestown, MA, CCN 223034

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michelle.gravallese.1@7605.direct.athenahealth.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.

• Sports Medicine North Orthopaedic Surgery, Inc.

  • Specialist
  • Peabody, MA
  • NPI 1760423719
  Medicare reassignment Care Compare group
• Sports Medicine North Orthopaedic Surgery, Inc

  dba Physical Therapy North

  • Multi-Specialty Clinic/Center
  • Gloucester, MA
  • NPI 1679168652
  NPD

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

• Anna Jaques Hospital

  • General Acute Care Hospital
  • Newburyport, MA
  • NPI 1992779482
  Care Compare affiliation
• Northeast Hospital Corporation

  • General Acute Care Hospital
  • Beverly, MA
  • NPI 1316917941
  Care Compare affiliation
• Northeast Hospital Corporation

  • Psychiatric Hospital Unit
  • Beverly, MA
  • NPI 1407827710
  Care Compare affiliation
• The Spaulding Rehabilitation Hospital Corporation

  dba Spaulding Rehabilitation Hospital - Boston

  • Rehabilitation Hospital
  • Charlestown, MA
  • NPI 1780600825

  Inpatient rehabilitation facility

  Care Compare affiliation

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

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506297600000",
    "number": "1871910364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ORTHOPEDICS DR",
            "address_2": "2ND FLOOR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019601668",
            "telephone_number": "978-818-6350",
            "fax_number": "978-854-4811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ORTHOPEDICS DR",
            "address_2": "2ND FLOOR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019601668",
            "telephone_number": "978-818-6350",
            "fax_number": "978-854-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULEY",
        "first_name": "MICHELLE",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-24",
        "last_updated": "2017-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MA",
            "license": "PA4987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "GRAVALLESE",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Danielle Bornstein
• Lindsey Borr, ME
• Boston Addiction, LLC (Boston Addiction)
• Boston Brace International Inc (OP Specialty Bracing)
• Nicole Marie Boudreault
• Derna Bourdeau
• Danielle Bourgeois, MA, CCC-SLP
• Elizabeth Ashley Bousa
• Chrysi Boutari, DDS
• Kristina E Bowers

• Surgical Physician Assistant in Peabody, MA
• Providers in Peabody, MA by specialty
• Surgical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2017; 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.