Kenneth L Boss, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

052425 Issued in GA

Practice address

820 Maple St
Carrollton, GA 30117-3626

Phone

(678) 390-7915

NPI assigned

Feb 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Medical College of Georgia School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians

316 Family MedicineGroup PAC ID 6709159437, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Central Home Health Care, an Amedisys Company Home health agency, Douglasville, GA, CCN 117050
• Tanner Medical Center Villa Rica Hospital, Villa Rica, GA, CCN 110015
• Tanner Medical Center - Carrollton Hospital, Carrollton, GA, CCN 110011

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.boss.1@22071.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/22071/brand/1/csg/1/fhir/r4

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

• 316 Family Medicine

  • Family Medicine Physician
  • Bremen, GA
  • NPI 1861915647
  Medicare reassignment Care Compare group NPD
• Wellstreet of Georgia PC

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  Medicare reassignment Care Compare group NPD
• 3:16 Urgent Care LLC

  • Urgent Care Clinic/Center
  • Bremen, GA
  • NPI 1295695781

  Family Medicine

  Medicare reassignment NPD
• Carrollton Surgical Group, P. a.

  • Surgery Physician
  • Carrollton, GA
  • NPI 1417931825
  NPD (past)

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

• Amedisys Georgia, LLC

  • Home Health Agency
  • Douglasville, GA
  • NPI 1437117090
  Care Compare affiliation
• Tanner Medical Center, Inc

  • General Acute Care Hospital
  • Carrollton, GA
  • NPI 1801883780
  Care Compare affiliation
• TMC/Villa Rica Hospital, Inc

  • General Acute Care Hospital
  • Villa Rica, GA
  • NPI 1851388748
  Care Compare affiliation

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1104891472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 728",
            "city": "BREMEN",
            "state": "GA",
            "postal_code": "301100728",
            "telephone_number": "770-537-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 MAPLE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173626",
            "telephone_number": "678-390-7915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 Dallas Hwy",
            "address_2": "suite 101",
            "address_purpose": "LOCATION",
            "city": "Villa Rica",
            "state": "GA",
            "postal_code": "301801247",
            "country_code": "US",
            "telephone_number": "770-456-4411",
            "fax_number": "770-812-3582",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1009 Alabama Ave S",
            "address_purpose": "LOCATION",
            "city": "Bremen",
            "state": "GA",
            "postal_code": "301102501",
            "country_code": "US",
            "telephone_number": "678-821-6400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSS",
        "first_name": "KENNETH",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "052425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1861915647",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277491774A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Boeyink Eyecare PC
• Steven John Boeyink, OD
• Wendy Bojnowski
• Ashley Nicole Boling
• Victoria Briana Bonomo
• Andrea Logan Bossie, MS, RN, CNN, FNP-C
• Andrew Bourg, CRNA
• Bowdon-Mt Zion Primary Health Center Inc.
• Jashuni Aaliyah Bowles
• Lyndi Nicole Bowling, PNP

• Family Medicine Physician in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.