SANDRA BOUCICAUT NP
NPI 1760112213
Nurse Practitioner - Adult Health in East Patchogue, NY

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LA2200X and a focus in Adult Health.

Active since June 15, 2022PECOS EnrolledAccepts Medicare Assignment

285 SILLS RD BLDG 5-6, EAST PATCHOGUE, NY 11772(631) 228-5802(929) 455-9868 Get Directions Write a Review

NPPES record last updated: February 15, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Sandra Boucicaut Np NPPES

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

SANDRA BOUCICAUT NP (NPI 1760112213) is an individual adult health provider in East Patchogue, New York, licensed in New York (310360) and active in the NPI registry since June 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1760112213

Entity TypeIndividualFemale

Primary Taxonomy363LA2200X

Provider Legal NameSANDRA BOUCICAUTCredential: NP

Location Address285 SILLS RD BLDG 5-6East Patchogue, NY 11772-4869

Mailing Address14 Wall St Fl 9New York, NY 10005-2178

Phone(631) 228-5802

Fax(929) 455-9868

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateJune 15, 2022

Last NPPES UpdateFebruary 15, 2024

NPPES CertifiedFebruary 15, 2024

✔ NPI 1760112213 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2200X

License✔ Licensed in NY · 310360

285 SILLS RD BLDG 5-6, East Patchogue, NY 11772

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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 and accepts Medicare assignment

Sandra Boucicaut Np 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 ID4880067479

PECOS Enrollment IDI20230301002315

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 11772 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

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

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.