NPIMap

Organization Active NPI

I Am Boundless, Inc.

Doing business as Boundless Health

  • Clinic/Center
  • Worthington, OH
National Provider Identifier
1063230175
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
I AM BOUNDLESS, INC.
Doing business as
Boundless Health
Practice address
445 E Dublin Granville Rd Ste H
Worthington, OH 43085-3192
Phone
(614) 844-3800
Fax
(614) 515-5779
NPI assigned
Sep 27, 2024
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
I AM BOUNDLESS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Laurie B Hickman
Title
Contracting & Credentialing Manager
Phone
(614) 844-3800

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Family Medicine Physician 207Q00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

445 E Dublin Granville Rd Ste H
Worthington, OH 43085-3192

Mailing address

445 E Dublin Granville Rd Ste H
Worthington, OH 43085-3192
Phone (614) 844-3800

Other names 1

  • Boundless Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220419000971 OH Part B Supplier - Clinic/Group Practice 9931596103 Receives reassigned benefits from 23 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newark, OH; Worthington, OH; West Carrollton, OH; Perrysburg, OH; Mineral Ridge, OH; Medina, OH; Columbus, OH

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
I Am Boundless Inc31 organizations share this tax ID, including this one
Part of
I Am Boundless Inc

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

Locations

22 N 1st St
Newark, OH 43055
Phone (740) 334-4056

28555 Starbright Blvd
Rossford, OH 43551
Phone (419) 887-8771

Practitioners & affiliated clinicians

Practitioners 58

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1063230175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 E DUBLIN GRANVILLE RD STE H",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430853192",
            "telephone_number": "614-844-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 E DUBLIN GRANVILLE RD STE H",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430853192",
            "telephone_number": "614-844-3800",
            "fax_number": "614-515-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I AM BOUNDLESS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "I AM BOUNDLESS, INC.",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CONTRACTING & CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "614-844-3800"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boundless Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boundless Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Worthington, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.