Jacob Paul Boucher, in Grafton, WI - Medicare Physical Therapist Provider

Jacob Paul Boucher, is a medicare enrolled "Physical Therapist - Orthopedic" provider in Grafton, Wisconsin. His current practice location is 1235 Dakota Dr Ste L, Grafton, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (262) 376-2085.

Jacob Paul Boucher is licensed to practice in Wisconsin (license number 17078-24) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1619501442.

Contact Information

	Jacob Paul Boucher,
	1235 Dakota Dr Ste L, Grafton, WI 53024-9477
	(262) 376-2085
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Jacob Paul Boucher
Gender	Male
Speciality	Physical Therapist - Orthopedic
Location	1235 Dakota Dr Ste L, Grafton, Wisconsin
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1619501442
Provider Enumeration Date: 03/02/2020
Last Update Date: 03/27/2025

Medicare PECOS Information:

PECOS PAC ID: 6507383494
Enrollment ID: I20250505001623

Medical Identifiers

Medical identifiers for Jacob Paul Boucher such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1619501442	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
2251X0800X	Physical Therapist - Orthopedic	17078-24 (Wisconsin)	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. Jacob Paul Boucher allows following entities to bill medicare on his behalf.

Provider Name	Freedom Physical Therapy Services Sc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1063406544 PECOS PAC ID: 8224938113 Enrollment ID: O20040108000955

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. Jacob Paul Boucher 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
Jacob Paul Boucher, 2001 Alford Park Dr, Kenosha, WI 53140-1927 Ph: (262) 424-5253	Jacob Paul Boucher, 1235 Dakota Dr Ste L, Grafton, WI 53024-9477 Ph: (262) 376-2085

Reviews and Comments

Physical Therapist in Grafton, WI

Anne R. Harley, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 975 Port Washington Rd, Grafton, WI 53024 Phone: 262-329-1000 Fax: 262-376-6020
Jessica Lynn Meeusen, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 2020 Cheyenne Ct, Grafton, WI 53024 Phone: 262-375-1075 Fax: 262-375-4975
Christopher David Potter, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 975 Port Washington Rd, Grafton, WI 53024 Phone: 262-329-2700
Athletico Ltd Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2225 Wisconsin Ave Ste 100, Grafton, WI 53024 Phone: 262-474-0063 Fax: 262-222-6281
Mrs. Lauren Monticelli, MSPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 975 Port Washington Rd, Grafton, WI 53024 Phone: 262-329-2700
Ms. Abbey Lynn Valentine, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 975 Port Washington Rd, Grafton, WI 53024 Phone: 262-329-4888
Charise L. Kelm, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 215 Washington St, Grafton, WI 53024 Phone: 262-375-3700 Fax: 262-376-6032

Jacob Paul Boucher, - Medicare Physical Therapist in Grafton, WI