Eman Boulis, MD
Individual provider Active NPI Rheumatology Physician · Grinnell, IA
NPI 1265617047 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1265617047
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Rheumatology Physician 207RR0500X
- License
- 20150 (MS)
- Practice address
- 210 4TH Ave
Grinnell, IA 50112-1898 - Phone
- (641) 236-7511
- Fax
- (641) 236-2058
- NPI assigned
- Dec 31, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Rheumatology
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- County of Ward
Practice addresses (Care Compare)
406 S Gary Ave
Monahans, TX 79756-4799
Phone (432) 943-2511
Hospital & facility affiliations
- Ward Memorial Hospital
- Reeves Regional Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210902000137 | TX | Practitioner - Rheumatology | 9032299433 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD433023 | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Ward | Current | Accepting new patients | |
| County of Ward | Current | Accepting new patients | |
| County of Ward | Current |
Accepting new patients | |
| County of Ward | Current |
Accepting new patients | |
| Incare LLC | Internal Medicine | Past | Accepting new patients |
| River Oaks Management Company LLC | Internal Medicine | Past | Accepting new patients |
Locations
813 E 4th St
Monahans, TX 79756
Phone (432) 943-2068
406 S Gary Ave
Monahans, TX 79756
Phone (432) 943-2511
Interoperability endpoints
- emanboulis@grmc.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD433023 | PA | |
| Rheumatology Physician | 207RR0500X | 20150 | MS | Yes |
| Rheumatology Physician | 207RR0500X | MD-41825 | IA |
Addresses
Primary practice location
210 4TH Ave
Grinnell, IA 50112-1898
Mailing address
210 4TH Ave
Grinnell, IA 50112-1898
Phone (641) 236-7511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD-41825 | Other | IA | IA LICENSE |
| 1246481 | Other | IA | IA CSA |
| 102065830 | Medicaid | PA |
Other providers in Grinnell, IA
- Anneliese Barton
- Scott William Baumann
- Wendi Lynn Beck
- Katelyn Sue Beyer
- Haley Bird
- Jacob Daniel Boyer
- Darius Kemar Bradford
- Michelle Brennan
- Jody Marie Brink
- Brian James Brown
All providers in Grinnell, IA · Rheumatology Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.