Tony Boualoy, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

11022498A Issued in IN

Practice address

12913 Arabian CT
Pickerington, OH 43147-8112

Phone

(614) 753-6324

NPI assigned

Mar 30, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: tboualoy486657@direct.parkviewexchange.com

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1346980158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 W COLUMBIA ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021725",
            "telephone_number": "614-753-6324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12913 ARABIAN CT",
            "city": "PICKERINGTON",
            "state": "OH",
            "postal_code": "431478112",
            "telephone_number": "614-753-6324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUALOY",
        "first_name": "TONY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-30",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "11022498A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyla Bope, CNP
• Brittany Borden
• Jolynn Marie Borowicz
• Alecia Ann Boswell
• Allissa Boswell
• Stephanie Marie Bowen
• Dana L Bower, LMT
• Stephanie Danelle Bowling, CTRS
• Louis Leo Bowman, DO
• Shannon Marie Boyer

• Surgery Physician in Pickerington, OH
• Providers in Pickerington, OH by specialty
• Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.