Marian Ruth Bouchard, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0420008790 Issued in VT

Practice address

30 Mountain St
Bristol, VT 05443-1310

Phone

(802) 453-4696

Fax

(802) 471-0360

NPI assigned

Jan 31, 2007

Last updated

May 1, 2020By 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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2020 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marian.bouchard@212299464507396.direct.elationemr.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.

• Mountain Health Center

  • Family Medicine Physician
  • Bristol, VT
  • NPI 1003939463
  NPD
• Porter Hospital Inc

  • Multi-Specialty Clinic/Center
  • Middlebury, VT
  • NPI 1780770511
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588291200000",
    "number": "1891832457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MOUNTAIN ST",
            "city": "BRISTOL",
            "state": "VT",
            "postal_code": "054431310",
            "telephone_number": "802-453-4696",
            "fax_number": "802-471-0360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MOUNTAIN ST",
            "city": "BRISTOL",
            "state": "VT",
            "postal_code": "054431310",
            "telephone_number": "802-453-4696",
            "fax_number": "802-471-0360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHARD",
        "first_name": "MARIAN",
        "middle_name": "RUTH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "0420008790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN0681",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mohammed Moeeduddin Ahmed, BDS, MDS
• Mary Colleen Anderson, DDS
• Brian D. Bates, MD
• Charles A Biss, LICSW
• Body and Mind Physical Therapy, PLC (Bristol Physical Therapy)
• Renee Bratspis, M.D.
• Bristol Internal Medicine, PC
• Bristol Park Dental Associates PLC
• Bristol Rescue Squad, Inc.
• Teresa Marie Burns

• Family Medicine Physician in Bristol, VT
• Providers in Bristol, VT by specialty
• Family Medicine Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.