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DR. JACOB BOUDREAUX MD
NPI 1497336838
Student in an Organized Health Care Education/Training Program in Augusta, GA

Active since April 17, 2021PECOS Enrolled
1120 15TH ST # BI2144, AUGUSTA, GA 30912(706) 910-8827 Get Directions Write a Review

NPPES record last updated: August 19, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 19, 2022, Aug 15, 2021, Apr 30, 2021 and 1 more (4 updates tracked since 2021).

About Dr. Jacob Boudreaux Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACOB BOUDREAUX MD (NPI 1497336838) is an individual student in an organized health care education/training program in Augusta, Georgia and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1497336838
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. JACOB BOUDREAUXCredential: MD
Location Address1120 15TH ST # BI2144Augusta, GA 30912-2426
Mailing Address1120 15th St # Bi2144Augusta, GA 30912-0004
Phone(706) 910-8827
Sole ProprietorNo
Enumeration DateApril 17, 2021
Last NPPES UpdateAugust 19, 20224 updates tracked since enumeration
NPPES CertifiedAugust 17, 2022
✔ NPI 1497336838 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1120 15TH ST # BI2144, Augusta, GA 30912
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jacob Boudreaux Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALLYSA CHEESMAN MD
Anesthesiology
1120 15TH ST # BI2144
AUGUSTA, GA 30912
Richmond County (706) 721-0180
SOPHIE QAJARI
Anesthesiology
1120 15TH ST # BI2144
AUGUSTA, GA 30912
Richmond County (762) 375-5836
DR. AMJAD NAJIM M.D.
Anesthesiology
1120 15TH ST # BI2144
AUGUSTA, GA 30912
Richmond County (706) 721-2273

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Boudreaux's NPI number?

The NPI number for Jacob Boudreaux is 1497336838. It was assigned to this individual provider in the NPPES registry on April 17, 2021.

Where is Jacob Boudreaux located?

Jacob Boudreaux practices at 1120 15th St # Bi2144, Augusta, GA 30912. The listed phone number is (706) 910-8827.

What is Jacob Boudreaux's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jacob Boudreaux enrolled in Medicare?

Yes. Jacob Boudreaux is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacob Boudreaux was last updated on August 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.