Jaz Cicero Santana Boyce

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Practice address

3118 Houston Dr
Columbus, OH 43207-3398

Phone

(614) 407-6352

NPI assigned

Jul 16, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other names 1

• Eijaz Kaytennae Shabazz El Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1468627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1083067896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3118 HOUSTON DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432073398",
            "telephone_number": "614-407-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3118 HOUSTON DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432073398",
            "telephone_number": "614-407-6352"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2167 Mock Rd",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432191284",
            "country_code": "US",
            "telephone_number": "614-407-6352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOYCE",
        "first_name": "JAZ",
        "middle_name": "CICERO SANTANA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-16",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EIJAZ",
            "last_name": "SHABAZZ EL",
            "middle_name": "KAYTENNAE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Laura Boxley, PH.D.
• Jessica A. Boxwell, APRN-CNP
• Elizabeth Sterling Boyadzhiev, LISW-S
• Caltis Mark Boyce
• Gwendolyn Ann Boyce, MA
• John Derek Boyce Sr., N/A
• Karen S Boyce, MA, BSSW
• Kelley Boyce, LISW-S
• Misty Boyce
• Sara Boyd Falvo, D.O.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Columbus, OH
• Providers in Columbus, OH by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.