Boundless Nutrition LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BOUNDLESS NUTRITION LLC

Practice address

13112 Moss Ranch LN
Fairfax, VA 22033-3524

Phone

(703) 705-2720

NPI assigned

Nov 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miriam Eackloff, RDNPI 1427608165

Title

Owner

Phone

(703) 705-2720

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Miriam Eackloff, RD

  • Registered Dietitian
  • Springfield, VA
  • NPI 1427608165

  DC

  Medicare reassignment NPD Authorized official
• Alisha Justine Murphy, RDN

  • Registered Dietitian
  • Fairfax, VA
  • NPI 1538982277

  DC

  Medicare reassignment NPD
• Alexandra J Burns, RDN

  • Registered Dietitian
  • Edwards, CO
  • NPI 1114666534

  DC

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1033828694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13112 MOSS RANCH LN",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333524",
            "telephone_number": "703-705-2720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13112 MOSS RANCH LN",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333524",
            "telephone_number": "703-705-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNDLESS NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-22",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A",
        "authorized_official_last_name": "EACKLOFF",
        "authorized_official_first_name": "MIRIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-705-2720",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Botz
• Michelle Bouboulis, OTR/L
• Anna Bougie, RDN
• Boulevard Dental Clinic
• Boulevard Operator LLC
• Mary Ann Bourgeois
• Kailey E Bousquet
• Martha Jean Bouveron
• Astrid Bovet, L.C.S.W.
• Antoine Rashad Bowe, OWNER

• Clinic/Center in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.