Ronald Boudouris, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12263 Issued in OH

Practice address

885 Commerce Dr
Perrysburg, OH 43551-5267

Phone

(419) 330-1349

NPI assigned

Jun 18, 2006

Last updated

May 5, 2017By 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

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

OhioguidestoneGroup PAC ID 5597910935, 60 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Ohioguidestone

  • Developmental - Behavioral Pediatrics Physician
  • Berea, OH
  • NPI 1609123728
  Medicare reassignment Care Compare group NPD
• Ohioguidestone

  • Community/Behavioral Health Agency
  • Berea, OH
  • NPI 1295096758
  NPD
• Ohioguidestone

  • Family Medicine Physician
  • Lorain, OH
  • NPI 1487452603
  NPD
• Ohioguidestone

  • Community/Behavioral Health Agency
  • Berea, OH
  • NPI 1174680557
  NPD (past)

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493942400000",
    "number": "1417992991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 W SOUTH BOUNDARY ST",
            "address_2": "STE 600",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515249",
            "telephone_number": "419-873-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 COMMERCE DR",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515267",
            "telephone_number": "419-330-1349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDOURIS",
        "first_name": "RONALD",
        "name_prefix": "Mr.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2017-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "12263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sarah Boris, APRN
• Stephanie A Born, PH.D., RD, LD
• Elena Maria Clara Bortoleto
• Lacey Bova
• Theodore Henry Bowlus, DPM
• Kristen Bradesku, PHARMD
• Christina Brancheau, M.S., CCC/SLP
• Valerie Sue Brandal, PSYD, LMSW, LISW-S

• Clinical Social Worker in Perrysburg, OH
• Providers in Perrysburg, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2017; 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.