Active NPI
Ronald Paul Bouffard, BS DC DABCI
- Chiropractor
- Boothbay Harbor, ME
National Provider Identifier
1922051473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CR1032
- Practice address
- 18 West Street
Boothbay Harbor, ME 04538-1849 - Phone
- (207) 633-5500
- Fax
- (207) 633-0805
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CR1032 | ME | Primary |
Addresses
Primary practice location
18 West Street
Boothbay Harbor, ME 04538-1849
Mailing address
18 West Street
Boothbay Harbor, ME 04538-1849
Phone (207) 633-5500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 030232 | Other | ME | ANTHEM/BC BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME, IL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080326000959 | ME | Practitioner - Chiropractic | 5193755114 | |
| I20220714000762 | IL | Practitioner - Chiropractic | 5193755114 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Active Wellness, LLC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Chicago, IL
- NPI 1265847545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516320000000",
"number": "1922051473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 WEST STREET",
"city": "BOOTHBAY HARBOR",
"state": "ME",
"postal_code": "045381849",
"telephone_number": "207-633-5500",
"fax_number": "207-633-0805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 WEST STREET",
"city": "BOOTHBAY HARBOR",
"state": "ME",
"postal_code": "045381849",
"telephone_number": "207-633-5500",
"fax_number": "207-633-0805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUFFARD",
"first_name": "RONALD",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "BS DC DABCI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2018-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ME",
"license": "CR1032",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM/BC BLUE SHIELD",
"identifier": "030232",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boothbay Harbor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.