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MR. MARC PATRICK BOULANGER II DNP, PMHNP-BC
NPI 1639063266
Nurse Practitioner - Psychiatric/Mental Health in San Diego, CA

Active since June 06, 2025PECOS EnrolledAccepts Medicare Assignment
200 W ARBOR DR, SAN DIEGO, CA 92103(800) 926-8273(888) 539-8781 Get Directions Write a Review

NPPES record last updated: June 5, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 5, 2026, Nov 5, 2025, Jun 6, 2025 (3 updates tracked since 2025).

About Mr. Marc Patrick Boulanger Ii Dnp, Pmhnp-bc NPPES

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

MR. MARC PATRICK BOULANGER II DNP, PMHNP-BC (NPI 1639063266) is an individual psychiatric/mental health provider in San Diego, California, licensed in California (95035464) and active in the NPI registry since June 2025. He is enrolled in Medicare PECOS, maintains 4 additional practice locations, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1639063266
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameMR. MARC PATRICK BOULANGER IICredential: DNP, PMHNP-BC
Location Address200 W ARBOR DRSan Diego, CA 92103-9000
Mailing AddressFile 57326Los Angeles, CA 90074-0001
Phone(800) 926-8273
Fax(888) 539-8781
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateJune 6, 2025
Last NPPES UpdateJune 5, 20263 updates tracked since enumeration
NPPES CertifiedJune 5, 2026
✔ NPI 1639063266 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in CA · 95035464
200 W ARBOR DR, San Diego, CA 92103
Open in Google Maps ↗

Secondary Practice Locations 4

Location 13350 La Jolla Village DrSan Diego, CA 92161-0002 · Phone (858) 552-8585
Location 26363 Greenwich DrSan Diego, CA 92122-5947 · Phone (800) 926-8273 · Fax (888) 539-8781
Location 36655 Alvarado RdSan Diego, CA 92120-5208 · Phone (800) 926-8273 · Fax (888) 539-8781
Location 4350 Dickinson St Ste 325San Diego, CA 92103-1913 · Phone (800) 926-8273 · Fax (888) 539-8781

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

Mr. Marc Patrick Boulanger Ii Dnp, Pmhnp-bc 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.

PECOS PAC ID9436640307
PECOS Enrollment IDI20251118004600
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Marc Boulanger reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Regents Of The University Of California
Same address
Psychiatry
200 W ARBOR DR
San Diego, CA 92103
  • Reassigned Medicare billing, California enrollment
  • 220 clinicians in this Medicare group
NPI 1508968967 (800) 926-8273
Community Research Foundation Inc
1.7 mi
Community/Behavioral Health
545 LAUREL ST
San Diego, CA 92101
  • Reassigned Medicare billing, California enrollment
  • 147 clinicians in this Medicare group
NPI 1225251812 (619) 233-4399

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92103 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$108.42 typical visit price
range $20.62 – $151.42
Typical copayment $27.10 (range $5.15 – $37.85)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

DR. RAMIN MOTARJEMI M.D.
Internal Medicine (Geriatric Medicine)
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (858) 249-2500
DR. KYLE PALMER EDMONDS M.D., FAAHPM
Hospice, Inpatient
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
SHAWN RAVEENTH VEDAMANI MD
Anesthesiology
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
DALE MICHAEL TRUJILLO NP
Nurse Practitioner
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
DR. EUGENE THOMAS RICHARDSON IV MD
Internal Medicine (Infectious Disease)
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
KAYLEE PETERSEN ARNP
Nurse Practitioner (Psychiatric/Mental Health)
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
IRENE NEVAREZ NP
Nurse Practitioner
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
WILLIAM JAMES MOSS M.D.
Student in an Organized Health Care Education/Training Program
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (508) 395-4189

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 Marc Boulanger's NPI number?

The NPI number for Marc Boulanger is 1639063266. It was assigned to this individual provider in the NPPES registry on June 6, 2025.

Where is Marc Boulanger located?

Marc Boulanger practices at 200 W Arbor Dr, San Diego, CA 92103. The listed phone number is (800) 926-8273.

What is Marc Boulanger's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Marc Boulanger enrolled in Medicare?

Yes. Marc Boulanger 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 organizations bill Medicare for Marc Boulanger's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Marc Boulanger reassigns Medicare benefits to 2 organizations: Regents Of The University Of California (San Diego, CA) and Community Research Foundation Inc (San Diego, CA). Each 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 Marc Boulanger's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Marc Boulanger was last updated on June 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.