1. Home
  2. Directory
  3. Massachusetts
  4. Boston
  5. Pediatrics
  6. NPI Profile

WALLACE BOURGEOIS M.D.
NPI 1811317209
Pediatrics - Pediatric Hematology-Oncology in Boston, MA

Active since April 24, 2014PECOS Enrolled
450 BROOKLINE AVE, BOSTON, MA 02215(617) 632-2423 Get Directions Write a Review

NPPES record last updated: February 22, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Feb 22, 2021, Jul 4, 2018 (2 updates tracked since 2018).

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.

NPPES Registry Identity

NPI1811317209
Entity TypeIndividualMale
Primary Taxonomy2080P0207X
Provider Legal NameWALLACE BOURGEOISCredential: M.D.
Location Address450 BROOKLINE AVEBoston, MA 02215-5418
Mailing Address44 Binney St # D-3119Boston, MA 02115-6013
Phone(617) 632-2423
Sole ProprietorNo
Enumeration DateApril 24, 2014
Last NPPES UpdateFebruary 22, 20212 updates tracked since enumeration
NPPES CertifiedFebruary 22, 2021
✔ NPI 1811317209 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPediatrics · Pediatric Hematology-OncologyAllopathic & Osteopathic Physicians
Taxonomy Code2080P0207X
License✔ Licensed in MA · 274015
Definition
A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases.
Also ListedPediatricsTaxonomy 208000000X · License 274015 (MA)
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
450 BROOKLINE AVE, Boston, MA 02215
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.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)

Wallace Bourgeois 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.

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.

PRABHSIMRANJOT SINGH MD
Internal Medicine (Hematology & Oncology)
450 BROOKLINE AVE
BOSTON, MA 02215
Suffolk County (617) 582-7956
SHAWN MAGUIRE PA-C
Physician Assistant
450 BROOKLINE AVE
BOSTON, MA 02215
Suffolk County (617) 582-8487
KARINA FRANCA
Genetic Counselor, MS
450 BROOKLINE AVE
BOSTON, MA 02215
Suffolk County (857) 215-2285
DR. SUZANNE JAQUETH FORREST M.D.
Pediatrics (Pediatric Hematology-Oncology)
450 BROOKLINE AVE
BOSTON, MA 02215
Suffolk County (617) 632-3270
LAUREN KIRITSY MSW, LCSW
Counselor (Mental Health)
450 BROOKLINE AVE
BOSTON, MA 02215
Suffolk County (857) 215-3448
OFIR WOLAJ MD
Internal Medicine (Hematology & Oncology)
450 BROOKLINE AVE, DANA 2058
BOSTON, MA 02215
Suffolk County (617) 632-6139
JASON BATALHA AGPCNP-BC
Nurse Practitioner
450 BROOKLINE AVE
BOSTON, MA 02215
Suffolk County (617) 632-6140
FATIMA EMRAN AMIR MS, LGC
Genetic Counselor, MS
450 BROOKLINE AVE
BOSTON, MA 02215
Suffolk County (617) 632-3729

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.

What insurance does Wallace Bourgeois accept?

Health plans from Anthem Blue Cross and Blue Shield 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.