Individual provider Active NPI

Michelle McGraw Boisvert, MD

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1205465929
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A205177 Issued in CA
Practice address
Comnavsurfpac
2841 Rendova Rd
San Diego, CA 92155-5490
Phone
(619) 881-9169
NPI assigned
Apr 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Military Health Care Provider 171000000X
Internal Medicine Physician 207R00000X A205177 CA Primary

Addresses

Primary practice location

Comnavsurfpac
2841 Rendova Rd
San Diego, CA 92155-5490

Mailing address

Comnavsurfpac
2841 Rendova Rd
San Diego, CA 92155

Other practice location 1

34800 Bob Wilson Dr
San Diego, CA 92134-1098
Phone (619) 532-8225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20231020000205 VA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 4486000957

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A205177CAMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1585958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1205465929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "COMNAVSURFPAC",
            "address_2": "2841 RENDOVA RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COMNAVSURFPAC",
            "address_2": "2841 RENDOVA RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921555490",
            "telephone_number": "619-881-9169"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34800 Bob Wilson Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921341098",
            "country_code": "US",
            "telephone_number": "619-532-8225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOISVERT",
        "first_name": "MICHELLE",
        "middle_name": "MCGRAW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-04",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A205177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.