Individual provider Active NPI

Brooklynn Ashley Boulware, PA-C

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1154095727
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1840 South Street, 2ND Floor
Philadelphia, PA 19146-7422
Phone
(215) 893-2240
NPI assigned
Aug 5, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1840 South Street, 2ND Floor
Philadelphia, PA 19146-7422

Mailing address

1840 South Street, 2ND Floor
Philadelphia, PA 19146-7422
Phone (215) 893-2240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230415000033 PA Practitioner - Physician Assistant 1254607294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

1840 S St
Philadelphia, PA 19146-7411
Phone (215) 893-7085

3400 Spruce St
Philadelphia, PA 19104-4206

3400 Spruce Street 5 White BLDG
Oral and Maxillofacial Surgery Hup
Philadelphia, PA 19104-4206
Phone (215) 829-6079

800 Spruce St
Philadelphia, PA 19107-6130

800 Spruce St Cathcart Building
Penn Radiology Mobile Mammography Pennsylva
Philadelphia, PA 19107-6130
Phone (215) 829-3282

800 Spruce Street 10TH Floor
Pah Inpatient Consult Services
Philadelphia, PA 19107-5701
Phone (215) 829-7838

801 Spruce St
Philadelphia, PA 19107-5701

801 Spruce St 7TH Floor
Pennsylvania Hospital Reproductive Endocr
Philadelphia, PA 19107-5701
Phone (215) 829-2345

Hospital & facility affiliations

  • Pennsylvania Hospital Hospital, Philadelphia, PA, CCN 390226
  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111
  • Penn Presbyterian Medical Center Hospital, Philadelphia, PA, CCN 390223
  • Chester County Hospital Hospital, West Chester, PA, CCN 390179
  • Good Shepherd Penn Partners Long-term care hospital, Philadelphia, PA, CCN 392050

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince May 8, 2023 Accepting new patients
University of Penn-Medical Group CurrentSince May 8, 2023 Accepting new patients

Locations

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

1840 South St
Ste 2
Philadelphia, PA 19146
Phone (215) 545-7246

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1628121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1154095727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 SOUTH STREET, 2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191467422",
            "telephone_number": "215-893-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 SOUTH STREET, 2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191467422",
            "telephone_number": "215-893-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULWARE",
        "first_name": "BROOKLYNN",
        "middle_name": "ASHLEY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-05",
        "last_updated": "2023-06-08",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.