Carly Jo Boss, AGPCNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

4704297072 Issued in MI

Practice address

7751 Byron Center Ave SW Ste C
Byron Center, MI 49315-8001

Phone

(616) 267-7668

NPI assigned

Oct 25, 2021

Last updated

Jan 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Carly Jo Adkins Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cboss176442@epic00.corewelldirect.org

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.

• Reed City Hospital Corporation

  dba Corewell Health Reed City Hospital Professional

  • Family Medicine Physician
  • Reed City, MI
  • NPI 1831253798
  Medicare reassignment NPD
• Spectrum Health Primary Care Partners

  dba Corewell Health Medical Group West

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673
  Medicare reassignment NPD
• Spectrum Health United

  dba Corewell Health Greenville Hospital

  • General Acute Care Hospital
  • Greenville, MI
  • NPI 1457304495
  Medicare reassignment NPD
• Reed City Hospital Corporation

  dba Spectrum Health Reed City Hospital Nurse Practitioners

  • General Practice Registered Nurse
  • Reed City, MI
  • NPI 1366735219
  NPD
• Spectrum Health Primary Care Partners

  dba Corewell Health Medical Group West

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1689499667
  NPD
• Spectrum Health United

  dba Corewell Health Greenville Hospital Professional

  • Family Medicine Physician
  • Greenville, MI
  • NPI 1063781342
  NPD

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1487318606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-486-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7751 BYRON CENTER AVE SW STE C",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493158001",
            "telephone_number": "616-267-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSS",
        "first_name": "CARLY",
        "middle_name": "JO",
        "credential": "AGPCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-25",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704297072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "cadkins176442@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "7751 Byron Center Ave SW Ste C",
            "city": "Byron Center",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493158001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "7751 Byron Center Ave SW Ste C",
            "city": "Byron Center",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493158001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "ADKINS",
            "middle_name": "JO",
            "credential": "AGPCNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Miranda Nicole Blaine
• Lindsey Nicole Bandy Blodgett, LPC
• Bluebird Behavioral Services, LLC (Hi-5 ABA)
• Iris Boettcher, MD
• Savannah Boomstra
• Molly Brady
• Paul E. Braman, M.D.
• Britni Anne Bredeweg
• Jennifer Brink, MA LLP
• Grace Bruins, LLMSW

• Gerontology Nurse Practitioner in Byron Center, MI
• Providers in Byron Center, MI by specialty
• Gerontology Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; 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.