Active NPI
Carl Boulos, M.D.
- Student in an Organized Health Care Education/Training Program
- Cleveland, OH
National Provider Identifier
1023674397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 9500 Euclid Ave # JJ24
Cleveland, OH 44195-0001 - Phone
- (216) 444-2200
- NPI assigned
- May 13, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MI | Primary |
Addresses
Primary practice location
9500 Euclid Ave # JJ24
Cleveland, OH 44195-0001
Mailing address
Cleveland Clinic 9500 Euclid Avenue/JJ24
Cleveland, OH 44195-0001
Phone (216) 444-2200
Other practice location 1
3990 John R
Detroit, MI 48201
Phone (313) 745-7233
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684281600000",
"number": "1023674397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "CLEVELAND CLINIC 9500 EUCLID AVENUE/JJ24",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441950001",
"telephone_number": "216-444-2200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9500 EUCLID AVE # JJ24",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441950001",
"telephone_number": "216-444-2200"
}
],
"practiceLocations": [
{
"address_1": "3990 John R",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "48201",
"country_code": "US",
"telephone_number": "313-745-7233",
"fax_number": "313-993-3889",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOULOS",
"first_name": "CARL",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-13",
"last_updated": "2023-05-17",
"certification_date": "2023-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.