Collins Boampong

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP950000655 Issued in CA

Practice address

10935 Terra Vista Pkwy Apt 244
Rancho Cucamonga, CA 91730-6360

Phone

(909) 944-3205

NPI assigned

May 19, 2014

Last updated

Oct 19, 2020By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group NPD (past)
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• Providence Medical Foundation

  • Internal Medicine Physician
  • Santa Rosa, CA
  • NPI 1740584473
  NPD
• St Mary Specialty Clinic

  • Obstetrics & Gynecology Physician
  • Apple Valley, CA
  • NPI 1588972806
  NPD (past)

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

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1225449622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 MEDICAL CENTER DR",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111217",
            "telephone_number": "909-887-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10935 TERRA VISTA PKWY APT 244",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917306360",
            "telephone_number": "909-944-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOAMPONG",
        "first_name": "COLLINS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-19",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP950000655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "collinsboampong@sjhhandhmg.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "17095 Main St",
            "city": "Hesperia",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923456004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Blossom Psychotherapy and Services
• John M. Blucker, DC
• Blue Medical DME
• Blue Oak Medical Group
• Bluemedplus
• Tiana Bobo
• Alexander Bocade
• Gizel Bocanegra Lopez
• Bodylogics Health Services Inc.
• Randy Lee Boeglin Jr.

• Family Nurse Practitioner in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.