NPIMap

Individual provider Active NPI

John N. Boll Jr., D.O.

  • Family Medicine Physician
  • Williamsport, PA
National Provider Identifier
1073516944
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS010395L Issued in PA
Practice address
740 High St
Suite 4001
Williamsport, PA 17701-3100
Phone
(570) 321-2345
Fax
(570) 321-2359
NPI assigned
May 24, 2005
Last updated
Apr 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS010395L PA Primary
Obstetrics Physician 207VX0000X OS010395L PA

Addresses

Primary practice location

740 High St
Suite 4001
Williamsport, PA 17701-3100

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900

Other identifiers 2

IdentifierTypeStateIssuer
1026698040001MedicaidPA
64052707MedicaidKY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address john.n.boll@upmcdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120213000083 PA Practitioner - Family Practice 7719943489 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Susquehanna Physician ServicesGroup PAC ID 2264336460, 611 clinicians

Practice addresses (Care Compare)

740 High St
Suite 4001
Williamsport, PA 17701-3111
Phone (570) 321-2345

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.06 of 100Reported as group
Quality
62.07
Promoting interoperability
100
Improvement activities
40
Cost
74.81

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
OS010395LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Susquehanna Physician Services CurrentSince Feb 27, 2012 Accepting new patients
Susquehanna Physician Services Family Medicine CurrentSince Feb 27, 2012 Accepting new patients
Upmc Wellsboro CurrentSince Sep 26, 2025 Accepting new patients
Upmc Wellsboro CurrentSince Sep 26, 2025 Accepting new patients
Susquehanna Physician Services PastSince Sep 1, 2010 Accepting new patients

Locations

103 West Ave
Ste 203
Wellsboro, PA 16901
Phone (570) 724-3744

32-36 Central Ave
Wellsboro, PA 16901
Phone (570) 723-0100

9 Water St
Ofc Of
Wellsboro, PA 16901
Phone (570) 724-2325

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

700 High St
Williamsport, PA 17701
Phone (570) 321-2000

740 High St
Ste 1004
Williamsport, PA 17701
Phone (570) 321-3300

740 High St
Ste 4001
Williamsport, PA 17701
Phone (570) 321-2345

Interoperability endpoints

  • Direct secure messaging: jboll41864@upmc.direct-ci.com
  • Direct secure messaging: john.n.boll@upmcdirect.com

Organizations & group practices 5

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1073516944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 HIGH ST",
            "address_2": "SUITE 4001",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013100",
            "telephone_number": "570-321-2345",
            "fax_number": "570-321-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLL",
        "first_name": "JOHN",
        "middle_name": "N.",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS010395L",
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "PA",
            "license": "OS010395L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026698040001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64052707",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.n.boll@upmcdirect.com",
            "affiliation": "N",
            "address_1": "740 High St",
            "address_2": "Suite 4001",
            "city": "Williamsport",
            "state": "PA",
            "country_code": "US",
            "postal_code": "177013100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.