Maryana Carole Boulos, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

12851770-1205 Issued in UT

Practice address

1250 E 3900 S Ste 260
Salt Lake City, UT 84124-1371

Phone

(801) 265-2000

NPI assigned

Jun 18, 2019

Last updated

Nov 9, 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

Medicare fee-for-service enrollment

Enrolled in UT

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 1

Specialty

Family Practice

Education

University of Utah School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Utah Healthcare Institute IncGroup PAC ID 7719882562, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mark's Hospital Hospital, Salt Lake City, UT, CCN 460047

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mboulos@1208.direct.myezyaccess.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.

• Utah Healthcare Institute Inc

  dba St. Mark's Family Medicine

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1376597344
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northern Utah Healthcare Corporation

  dba St. Mark's Hospital

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1164469243
  Care Compare affiliation

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1598325821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 W 1000 N",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841161654",
            "telephone_number": "801-328-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 E 3900 S STE 260",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241371",
            "telephone_number": "801-265-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 Alhambra Ave",
            "address_purpose": "LOCATION",
            "city": "Martinez",
            "state": "CA",
            "postal_code": "945533156",
            "country_code": "US",
            "telephone_number": "925-370-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1365 W 1000 N",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841161654",
            "country_code": "US",
            "telephone_number": "801-328-5750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOULOS",
        "first_name": "MARYANA",
        "middle_name": "CAROLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "12851770-1205",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "12851770-1205-1205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorenzo Davide Botto, M.D.
• Elizabeth Leigh White Botts, MD
• Dana Boucek
• Dulce Elizabeth Boucher, M.D.
• Eleanor Catherine Bouley
• Anne E Boulter, APRN
• Nicole Kay Bouma
• Michael T. Bounajem, MD
• Matt C Bounds
• Tyndall Bounous

• Family Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.