Boulevard ENT Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BOULEVARD ENT SURGERY CENTER LLC

Practice address

9300 Park West Blvd
Knoxville, TN 37923-4301

Phone

(865) 427-4040

Fax

(865) 427-4041

NPI assigned

Mar 30, 2023

Organization subpart

No

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

Authorized official

Name

Janelle L Johnson, RN, BSN

Title

Administrative Director

Phone

(865) 427-4040

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

Boulevard ENT Surgery Center LLCCCN 44C0001218

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samuel Mark Overholt, M.D.

  • Otolaryngology Physician
  • Knoxville, TN
  • NPI 1417952482
  NPD
• Jameson Kyle Mattingly, M.D.

  • Otology & Neurotology Physician
  • Knoxville, TN
  • NPI 1255697975
  NPD (past)

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

{
    "created_epoch": "1680134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1528762671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9300 PARK WEST BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234301",
            "telephone_number": "865-427-4040",
            "fax_number": "865-427-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 PARK WEST BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234301",
            "telephone_number": "865-427-4040",
            "fax_number": "865-427-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD ENT SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-30",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JANELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "865-427-4040",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Robert Boughter
• Bria Wall Boukovalas, CRNA
• Stefanos Boukovalas, M.D.
• Heydon Bouldin
• Reid Boulet, DDS, MSC
• Kate Bounds, NP
• Matthew Wilson Bounds, MD
• Paula Marie Bourassa, RDH
• Deanna Bourke, BA
• James Thurman Bourland

• Ambulatory Surgical Clinic/Center in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.