Nathalie Boulos, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

S9270 Issued in TX

Practice address

301 Londonderry Dr
Waco, TX 76712-7915

Phone

(254) 751-4880

Fax

(254) 751-4885

NPI assigned

Aug 10, 2016

Last updated

May 12, 2023By 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 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO, TX2 enrollments

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 2

Specialty

Psychiatry

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Health AllianceGroup PAC ID 6305731068, 119 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nathalie.boulos.1@9635.direct.athenahealth.com
• Direct secure messaging: nathalie.boulos.md.1@9635.direct.athenahealth.com

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.

• Providence Health Alliance

  • Specialist
  • Waco, TX
  • NPI 1932210838
  Medicare reassignment Care Compare group NPD
• SLH Physicians LLC

  • Emergency Medicine Physician
  • Saint Louis, MO
  • NPI 1881668051

  Psychiatry

  Medicare reassignment NPD
• Providence Health Alliance

  dba Providence Family Health Clinic-Hillsboro

  • Rural Health Clinic/Center
  • Waco, TX
  • NPI 1336590462
  NPD

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683849600000",
    "number": "1548714397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LONDONDERRY DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127915",
            "telephone_number": "254-751-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 LONDONDERRY DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127915",
            "telephone_number": "254-751-4880",
            "fax_number": "254-751-4885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULOS",
        "first_name": "NATHALIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-10",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2019024539",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "S9270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nathalie.boulos@ascension.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "301 Londonderry Dr",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "767128097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bosque River Physical Therapy & Rehab
• Bosque River Physical Therapy and Rehabilitation Limited Partnership
• Bosqueville Isd
• James W Boss, MD
• Linda M Bostwick, NP
• Meryl Lee Boutte, CAA
• Kevin Bowcutt, D.D.S.
• James A Bowden, M.D.
• Anna Lilia Bowdoin
• Cheyenne E Bowers, COTA

• Psychiatry Physician in Waco, TX
• Providers in Waco, TX by specialty
• Psychiatry Physician in Texas

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