Michael J Boucher, MD
Individual provider Active NPI Emergency Medicine Physician · Mobile, AL
NPI 1922030808 · NPPES record last updated Aug 28, 2009
Key facts
- NPI
- 1922030808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- MD.16746 (AL)
- Practice address
- 5 Mobile Infirmary Cir
Mobile, AL 36607-3513 - Phone
- (251) 435-2646
- Fax
- (251) 435-6478
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- University of South Alabama College of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- City of Jackson Healthcare Authority
Practice addresses (Care Compare)
220 Hospital Dr
Jackson, AL 36545-2459
Phone (251) 246-1159
Hospital & facility affiliations
- Jackson Medical Center Home Health
- Jackson Medical Center
- Mobile Infirmary Medical Center
- Jackson Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050214000625 | AL | Practitioner - Emergency Medicine |
8820040207 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD.16746 | AL | MD | Emergency Medicine Physician |
| 16746 | AL | MD | Emergency Medical Services (Emergency Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| City of Jackson Healthcare Authority | Current |
Accepting new patients | |
| City of Jackson Healthcare Authority | Current |
Accepting new patients | |
| Emcare Physician Providers, Inc. | Emergency Medicine | Past | Accepting new patients |
| Mobile Emergency Group PC | Emergency Medicine | Past | Accepting new patients |
Locations
220 Hospital Dr
Jackson, AL 36545
Phone (251) 246-1159
229 Saint John Ln
Covington, LA 70433
Phone (866) 875-9225
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 16746 | AL | |
| Emergency Medicine Physician | 207P00000X | MD.16746 | AL | Yes |
Addresses
Primary practice location
5 Mobile Infirmary Cir
Mobile, AL 36607-3513
Mailing address
PO Box 10583
Birmingham, AL 35202-0583
Phone (251) 435-2646
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51533347 | Other | AL | BLUE CROSS |
| 51003502 | Other | AL | BLUE CROSS |
| 000098517 | Medicaid | AL | |
| 51098517 | Other | AL | BLUE CROSS |
| 009936088 | Medicaid | AL | |
| 009936091 | Medicaid | AL | |
| 009936089 | Medicaid | AL | |
| 51533346 | Other | AL | BLUE CROSS |
Other providers in Mobile, AL
- Anne Marie Boster
- Lisa M Boster
- Judith Boswell
- Jon Botts
- Helen Elizabeth Boucher
- Susan Marisa Boucher
- Floyd T Boudreau
- Carole Boudreaux
- Evangeline Simone Boudreaux
- Michael C Boudreaux
All providers in Mobile, AL · Emergency Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.