Jacqueline Boboescu, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704330344 Issued in MI

Practice address

8769 N Territorial Rd
Plymouth, MI 48170-5049

Phone

(734) 679-7477

NPI assigned

Jun 10, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Downriver Mental Health Clinic PCGroup PAC ID 7911995139, 289 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.jacquelineboboescu@150339.advancedmd-direct.com

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.

• Downriver Mental Health Clinic PC

  • Psychologist
  • Taylor, MI
  • NPI 1295866135
  Medicare reassignment Care Compare group NPD
• Downriver Mental Health Clinic PC

  • Psychologist
  • Taylor, MI
  • NPI 1104930130
  NPD

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1184466229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8769 N TERRITORIAL RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481705049",
            "telephone_number": "734-679-7477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8769 N TERRITORIAL RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481705049",
            "telephone_number": "734-679-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBOESCU",
        "first_name": "JACQUELINE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704330344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Bleyaert
• Barbara Blom, LCSW, CAC
• Derek Bloomer
• Hannah Marie Blosser
• Christine Blume
• Shaina Bodenhofer
• Christopher Bodnovits
• Body-Based Psychotherapy of Metro Detroit, PLLC
• Lauren Elizabeth Boesen
• Jennifer R Bogg, LMSW

• Psychiatric/Mental Health Nurse Practitioner in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; 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.