Dr Renee L Boulicault, MD in Kingsport, TN

Dr Renee L Boulicault, MD is a medicare enrolled "Hospitalist" physician in Kingsport, Tennessee. Her current practice location is 105 W Park Dr, Kingsport, Tennessee. You can reach out to her office (for appointments etc.) via phone at (423) 224-3220.

Dr Renee L Boulicault is licensed to practice in Tennessee (license number 70768) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1639148422.

Contact Information

	Dr Renee L Boulicault, MD
	105 W Park Dr, Kingsport, TN 37660-3805
	(423) 224-3220
	Not Available

Map and Direction

Physician's Profile

Full Name	Dr Renee L Boulicault
Gender	Female
Speciality	Hospitalist
Location	105 W Park Dr, Kingsport, Tennessee
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1639148422
Provider Enumeration Date: 03/15/2006
Last Update Date: 09/05/2025

Medicare PECOS Information:

PECOS PAC ID: 5799765152
Enrollment ID: I20051114000826

Medical Identifiers

Medical identifiers for Dr Renee L Boulicault such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1639148422	NPI	-	NPPES
1639148422	Medicaid	WI

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207V00000X	Obstetrics & Gynecology	4868-320 (Wisconsin)	Secondary
207V00000X	Obstetrics & Gynecology	103629 (Missouri)	Secondary
207V00000X	Obstetrics & Gynecology	70768 (Tennessee)	Secondary
208M00000X	Hospitalist	70768 (Tennessee)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Renee L Boulicault allows following entities to bill medicare on her behalf.

Entity Name	Mercy Clinic Springfield Communities
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1245277631 PECOS PAC ID: 7416865845 Enrollment ID: O20031104000060

Entity Name	Mercy Clinic Springfield Communities
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1972771657 PECOS PAC ID: 7416865845 Enrollment ID: O20031218000354

Entity Name	Women's Health Associates, Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1417926676 PECOS PAC ID: 9739078916 Enrollment ID: O20040315000565

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Renee L Boulicault is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Renee L Boulicault, MD 1021 W Oakland Ave Ste 310, Johnson City, TN 37604-2192 Ph: (423) 952-2111	Dr Renee L Boulicault, MD 105 W Park Dr, Kingsport, TN 37660-3805 Ph: (423) 224-3220

Reviews and Comments

Hospitalist Doctors in Kingsport, TN

Patrina Nicolyn Cradic, FNP-C Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 130 W Ravine Rd, Kingsport, TN 37660 Phone: 423-224-4000
Dr. Mark L Withrow, MD Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 105 W Stone Dr Ste 5d, Kingsport, TN 37660 Phone: 423-247-7500 Fax: 423-247-7556
Dr. William Boatwright Harris Jr., MD Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 105 W Park Dr, Kingsport, TN 37660 Phone: 423-224-3220
Jamie Kendall Bartley, DO Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 2000 Brookside Dr, 3rd Floor, Kingsport, TN 37660 Phone: 423-857-5905 Fax: 423-857-5904
Dr. Dennis Starr, MD Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 130 W Ravine Rd, Kingsport, TN 37660 Phone: 423-282-1480 Fax: 423-928-1353
Dan Frechtling, Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 4 Sheridan Sq Ste 200, Kingsport, TN 37660 Phone: 423-246-7931
Dr. Mircea Boiciuc, M.D. Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 2033 Meadowview Ln, Ste 200, Kingsport, TN 37660 Phone: 423-857-2793 Fax: 423-578-8025

Dr Renee L Boulicault, MD - Medicare Hospitalist in Kingsport, TN