Samuel Boggess
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Chardon, OH
NPI 1033912936 · NPPES record last updated Mar 28, 2025
Key facts
- NPI
- 1033912936
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 13207 Ravenna Rd
Chardon, OH 44024-7032 - Phone
- (877) 356-0756
- NPI assigned
- Mar 28, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250415002959 | OH | Order and Referring Only - Physical Medicine and Rehabilitation |
5991220600 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
13207 Ravenna Rd
Chardon, OH 44024-7032
Mailing address
13207 Ravenna Rd
Chardon, OH 44024-7032
Other providers in Chardon, OH
- Hannah Marie Blanton
- Kimberley Jane Blauch
- Kellie Blauman
- Nicholas Theodore Blevins
- Chelsey Lynn Boecker
- Christopher Bohac
- Sophia Bolden
- Nickole Bollini
- Nick Bondra
- Elizabeth Booker
All providers in Chardon, OH · Student in an Organized Health Care Education/Training Program in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.