Linda Georgette Boulware, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.022606 Issued in IL

Practice address

2045 W Grand Ave Ste B
Chicago, IL 60612-1577

Phone

(888) 660-4425

NPI assigned

Jan 8, 2021

Last updated

Jan 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Specialized Wound Management LLCGroup PAC ID 4284628173, 3 clinicians

Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health at Home Health-Illinois Home health agency, Mount Vernon, IL, CCN 147088
• Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046
• SSM Health St Mary's Hospital -Centralia Hospital, Centralia, IL, CCN 140034
• Deaconess Illinois Crossroads Hospital, Mount Vernon, IL, CCN 140294

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• Direct secure messaging: lboulware503006@direct-ehr-ssmhc.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Physician Services Corporation of Southern Illinois Inc.

  dba SSM Health Medical Group

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  Medicare reassignment Care Compare group NPD
• Specialized Wound Management LLC

  dba Specialized Wound Management

  • Adult Health Nurse Practitioner
  • Chesterfield, MO
  • NPI 1962430157

  IL

  Medicare reassignment Care Compare group NPD
• Perspective Behavioral and Pain Solutions LTD

  • Psychologist
  • Rosemont, IL
  • NPI 1326671702
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Deaconess Illinois Crossroads Inc

  dba Crossroads Community Hospital

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1124745807
  Care Compare affiliation
• Good Samaritan Regional Health Center

  dba SSM Health Good Samaritan Hospital - Mt. Vernon

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1609897339
  Care Compare affiliation
• SSM Health Businesses

  dba SSM Health at Home Home Health Glen Carbon

  • Home Health Agency
  • Mount Vernon, IL
  • NPI 1295798403
  Care Compare affiliation
• St Mary's Hospital, Centralia, Illinois

  dba SSM Health St. Mary's Hospital - Centralia

  • General Acute Care Hospital
  • Centralia, IL
  • NPI 1083617245
  Care Compare affiliation

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

{
    "created_epoch": "1610064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610064000000",
    "number": "1063000669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1591 ABBOTT ST",
            "city": "CARLYLE",
            "state": "IL",
            "postal_code": "622311107",
            "telephone_number": "618-741-8431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 W GRAND AVE STE B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121577",
            "telephone_number": "888-660-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULWARE",
        "first_name": "LINDA",
        "middle_name": "GEORGETTE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-08",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.022606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Robert Boulay, MD
• Bethany Page Bouldin, MD
• Boulevard Care Center
• Boulevard Counseling PLLC
• Symaya Boulrece
• Heather Anne Bouma-Johnston, MD
• Imane Boumaraf, MD
• Redouane Boumendjel, MD
• Christine Boumitri, M.D
• Bounce Cuisine LLC

• Family Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.