NPI Record of MR. DONALD FRANCIS BOUCHARD NPI 1003004532

Contractor in Chester, CT

Complete NPI Record

Field Name Value Definition
NPI1003004532The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code1Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Last Name Legal NameBOUCHARDThe last name of the provider. If the provider is an individual, this is the legal name.
Provider First NameDONALDThe first name of the provider, if the provider is an individual.
Provider Middle NameFRANCISThe middle name of the provider, if the provider is an individual.
Provider Name Prefix TextMR.The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider First Line Business Mailing Address17 WATERHOUSE LNThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing AddressGOLDSTAR MEDICAL SERVICES, INC.The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NameCHESTERThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameCTThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code06412The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number8605264333The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number8605264333The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address17 WATERHOUSE LNThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHESTERThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCTThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code064121267The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number8605264333The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number8605264333The fax number associated with the location address of the provider being identified.
Provider Enumeration Date10/10/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date10/10/2007The date that a record was last updated or changed.
Provider Gender CodeMThe code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1171W00000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number State Code 1CTThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Other Provider Identifier 112DME0363CT02Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 101Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1CT
Other Provider Identifier Issuer 1ANTHEM BLUE CROSS CT
Other Provider Identifier 2GO376254Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 201Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2CT
Other Provider Identifier Issuer 2BLUE CROSS/SHIELD MA
Is Sole ProprietorYCode indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No