DR. RENEE L BOULICAULT M.D.
NPI 1639148422
Hospitalist in Kingsport, TN

Q: What is Renee Boulicault's NPI number?

The NPI number for Renee Boulicault is 1639148422. It was assigned to this individual provider in the NPPES registry on March 15, 2006.

Q: What is Renee Boulicault's specialty?

The primary specialty registered for this NPI is Hospitalist with taxonomy code 208M00000X.

Q: When was this NPI record last updated?

The NPPES record for Renee Boulicault was last updated on September 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.

Active since March 15, 2006PECOS Enrolled

105 W PARK DR, KINGSPORT, TN 37660(423) 224-3220 Get Directions Write a Review

NPPES record last updated: September 5, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 5, 2025, Sep 26, 2024, Apr 26, 2024 (3 updates tracked since 2024).

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About Dr. Renee L Boulicault M.d. NPPES

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

DR. RENEE L BOULICAULT M.D. (NPI 1639148422) is an individual hospitalist provider in Kingsport, Tennessee, licensed in Tennessee (70768) and active in the NPI registry since March 2006. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1639148422

Entity TypeIndividualFemale

Primary Taxonomy208M00000X

Provider Legal NameDR. RENEE L BOULICAULTCredential: M.D.

Location Address105 W PARK DRKingsport, TN 37660-3805

Mailing Address1021 W Oakland Ave Ste 310Johnson City, TN 37604-2192 · (423) 952-2111 · Fax (423) 282-1657

Phone(423) 224-3220

Sole ProprietorNo

Enumeration DateMarch 15, 2006

Last NPPES UpdateSeptember 5, 20253 updates tracked since enumeration

NPPES CertifiedSeptember 5, 2025

✔ NPI 1639148422 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyHospitalistAllopathic & Osteopathic Physicians

Taxonomy Code208M00000X

License✔ Licensed in TN · 70768

Definition

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.

Also ListedObstetrics & GynecologyTaxonomy 207V00000X · License 4868-320 (WI), 103629 (MO), 70768 (TN)

105 W PARK DR, Kingsport, TN 37660

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Secondary Practice Locations 2

Location 11601 E Broadway, Suite 100Columbia, MO 65201-8020 · Phone (573) 443-8796 ext. 3003 · Fax (573) 875-3949

Location 23400 E Racine StJanesville, WI 53546-2344 · Phone (608) 373-8000 · Fax (608) 371-8928

Other Identifiers 1

Medicaid1639148422WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica, Mountain Health CO-OP, Providence Health Plan.Insurance ›

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. Renee L Boulicault M.d. 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37660 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

$121.80 typical visit price

range $52.64 – $160.89

Typical copayment $30.45 (range $13.16 – $40.22)

Most-billed visit code 99204

Established Patient

$93.60 typical visit price

range $16.72 – $131.41

Typical copayment $23.40 (range $4.18 – $32.85)

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 11

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

GREGG A WILLIS MD

Obstetrics & Gynecology