WALLACE BOURGEOIS M.D.
NPI 1811317209
Pediatrics - Pediatric Hematology-Oncology in Boston, MA
About Wallace Bourgeois M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WALLACE BOURGEOIS M.D. (NPI 1811317209) is an individual pediatric hematology-oncology provider in Boston, Massachusetts, licensed in Massachusetts (274015) and active in the NPI registry since April 2014. He is enrolled in Medicare PECOS and maintains a secondary practice location in Boston.
NPPES Registry Identity
Specialties & Licenses 3
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Wallace Bourgeois M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Wallace Bourgeois reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Boston, MA 02215
- Reassigned Medicare billing, Massachusetts enrollment
- 1,026 clinicians in this Medicare group
Boston, MA 02115
- Reassigned Medicare billing, Massachusetts enrollment
- 1,358 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 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
BOSTON, MA 02215
BOSTON, MA 02215
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 Wallace Bourgeois's NPI number?
The NPI number for Wallace Bourgeois is 1811317209. It was assigned to this individual provider in the NPPES registry on April 24, 2014.
Where is Wallace Bourgeois located?
Wallace Bourgeois practices at 450 Brookline Ave, Boston, MA 02215. The listed phone number is (617) 632-2423.
What is Wallace Bourgeois's specialty?
The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Hematology-Oncology, with taxonomy code 2080P0207X.
Is Wallace Bourgeois enrolled in Medicare?
Yes. Wallace Bourgeois is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Wallace Bourgeois's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Wallace Bourgeois reassigns Medicare benefits to 2 organizations: Dana-Farber Cancer Institute, Inc. (Boston, MA) and Children's Hospital Pediatric Associates, Inc (Boston, MA). 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 Wallace Bourgeois's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Wallace Bourgeois accept?
Health plans from Anthem Blue Cross and Blue Shield and Taro Health list Wallace Bourgeois 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 Wallace Bourgeois was last updated on February 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Wallace Bourgeois, M.D. · NPI 1811317209
Pediatric Hematology-Oncology physician in Boston, Massachusetts. Individual provider, active in the CMS NPPES registry since April 24, 2014.
## Identity
- **NPI:** 1811317209 (Entity type: Individual)
- **Enumerated:** April 24, 2014
- **Primary specialty:** Pediatrics - Pediatric Hematology-Oncology · taxonomy 2080P0207X
- **State license:** 274015 (Massachusetts)
- **Sole proprietor:** No
## Practice location
- **Address:** 450 BROOKLINE AVE, Boston, MA 02215-5418
- **Phone:** (617) 632-2423
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Dana-Farber Cancer Institute, Inc. (NPI 1851333686, Boston, MA); Children's Hospital Pediatric Associates, Inc (NPI 1457306664, Boston, MA) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 22, 2021
---
Source: [NPI Profile](https://npiprofile.com/npi/1811317209) · Data from the CMS NPPES public registry.