JACOB PAUL BOUCHER
NPI 1619501442
Physical Therapist - Orthopedic in Grafton, WI
About Jacob Paul Boucher NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACOB PAUL BOUCHER (NPI 1619501442) is an individual orthopedic provider in Grafton, Wisconsin, licensed in Wisconsin (17078-24) and active in the NPI registry since March 2020. He is a graduate of Other (2024).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jacob Paul Boucher is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jacob Boucher reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Fox Point, WI 53217
- Reassigned Medicare billing, Wisconsin enrollment
- 40 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Boucher's NPI number?
The NPI number for Jacob Boucher is 1619501442. It was assigned to this individual provider in the NPPES registry on March 2, 2020.
Where is Jacob Boucher located?
Jacob Boucher practices at 1235 Dakota Dr Ste L, Grafton, WI 53024. The listed phone number is (262) 376-2085.
What is Jacob Boucher's specialty?
The primary specialty registered for this NPI is Physical Therapist, specializing in Orthopedic, with taxonomy code 2251X0800X.
Is Jacob Boucher enrolled in Medicare?
Yes. Jacob Boucher is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jacob Boucher's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Boucher reassigns Medicare benefits to Freedom Physical Therapy Services Sc (Fox Point, WI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacob Boucher's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jacob Boucher accept?
Health plans from UnitedHealthcare list Jacob Boucher as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jacob Boucher was last updated on March 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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.
# Jacob Paul Boucher · NPI 1619501442
Orthopedic provider in Grafton, Wisconsin. Individual provider, active in the CMS NPPES registry since March 2, 2020.
## Identity
- **NPI:** 1619501442 (Entity type: Individual)
- **Enumerated:** March 2, 2020
- **Primary specialty:** Physical Therapist - Orthopedic · taxonomy 2251X0800X
- **State license:** 17078-24 (Wisconsin)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1235 DAKOTA DR STE L, Grafton, WI 53024-9477
- **Phone:** (262) 376-2085
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** Freedom Physical Therapy Services Sc (NPI 1063406544, Fox Point, WI), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** March 27, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1619501442) · Data from the CMS NPPES public registry.