Alex R Boller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004090 Issued in NY

Practice address

301 Hiwassee Community Dr.
Madisonville, TN 37354

Phone

(423) 436-7730

Fax

(423) 436-0384

NPI assigned

Dec 23, 2005

Last updated

Mar 7, 2023By 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 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NY, TN2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: alex.boller@931273876307972.direct.elationemr.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.

• Esopus Medical, PC

  • Family Medicine Physician
  • Rifton, NY
  • NPI 1295701787

  TN

  Medicare reassignment
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  TN

  Medicare reassignment

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1568449205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HIWASSEE COMMUNITY DR.",
            "address_2": "SUITE 100",
            "city": "MADISONVILLE",
            "state": "TN",
            "postal_code": "37354",
            "telephone_number": "423-436-7730",
            "fax_number": "423-436-0384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HIWASSEE COMMUNITY DR.",
            "city": "MADISONVILLE",
            "state": "TN",
            "postal_code": "37354",
            "telephone_number": "423-436-7730",
            "fax_number": "423-436-0384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLER",
        "first_name": "ALEX",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2023-03-07",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA-001385-L",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "004090",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "4902",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MA-001385-L",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA #",
            "identifier": "910248",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "004090",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mazie Bivens
• Melinda Blair
• Crystal Bledsoe
• Terri Murr Block, LCSW
• Amy Bloomer
• Teresa Lorreen Bond, LMT
• Kelsey Boring, SLP
• Linda W Boyatt, ARNP
• Valerie Boyd, DIS
• William Paul Brakebill Jr., DDS

• Physician Assistant in Madisonville, TN
• Providers in Madisonville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.