NPIMap

Individual provider Active NPI

Nicholas M Boulis, MD

  • Neurological Surgery Physician
  • Atlanta, GA
National Provider Identifier
1164485041
Registry record updated Oct 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
059605 Issued in GA
Practice address
1365 Clifton Rd NE # Clinicb
Atlanta, GA 30322
Phone
(404) 727-2247
NPI assigned
Apr 11, 2006
Last updated
Oct 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 059605 GA Primary
Neurological Surgery Physician 207T00000X 35079749B OH

Addresses

Primary practice location

1365 Clifton Rd NE # Clinicb
Atlanta, GA 30322

Mailing address

1365B Clifton Rd NE Ste B6200
Atlanta, GA 30322-1013
Phone (404) 727-2247

Other practice location 1

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (800) 223-2273

Other identifiers 1

IdentifierTypeStateIssuer
2258775MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20071012000224 GA Practitioner - Neurosurgery 8224040530 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Harvard Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
059605GAMDNeurological Surgery Physician
35079749BOHMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Emory Clinic Inc CurrentSince Aug 1, 2007 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Emory University Past Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

1365 Clifton Rd NE
#2200
Atlanta, GA 30322

1365 Clifton Rd NE
Ste B6200
Atlanta, GA 30322
Phone (404) 778-5770

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

Interoperability endpoints

  • Direct secure messaging: nboulis21697@direct.emory.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539561600000",
    "number": "1164485041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365B CLIFTON RD NE STE B6200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221013",
            "telephone_number": "404-727-2247",
            "fax_number": "404-712-8576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 CLIFTON RD NE # CLINICB",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30322",
            "telephone_number": "404-727-2247"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9500 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441950001",
            "country_code": "US",
            "telephone_number": "800-223-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOULIS",
        "first_name": "NICHOLAS",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2018-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "059605",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "OH",
            "license": "35079749B",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2258775",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.