Christopher George Boller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

072771-1 Issued in NY

Practice address

10819 Rockaway Blvd
South Ozone Park, NY 11420-1034

Phone

(718) 845-2620

Fax

(718) 845-9380

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14448/brand/1/csg/1/fhir/r4
• Direct secure messaging: christopher.boller.1@14448.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 and National Provider Directory roles.

• St John'S Medical Services PC

  • Internal Medicine Physician
  • Far Rockaway, NY
  • NPI 1023042173
  NPD
• Episcopal Health Services Inc

  • Community/Retail Pharmacy
  • Far Rockaway, NY
  • NPI 1689151201
  NPD (past)

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251072000000",
    "number": "1609921121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15122 85TH DR",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114322510",
            "telephone_number": "171-873-9392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10819 ROCKAWAY BLVD",
            "city": "SOUTH OZONE PARK",
            "state": "NY",
            "postal_code": "114201034",
            "telephone_number": "718-845-2620",
            "fax_number": "718-845-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLER",
        "first_name": "CHRISTOPHER",
        "middle_name": "GEORGE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2009-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "072771-1",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "072771-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00072771",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "072771-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tejkumar Bhulai
• Rebecca Bisnauth, OTR/L
• Latchman Bisram
• Paul Stephan Bliok, LMSW
• Cynthia Espina Bolante
• Jay Bee G Bondoc
• Irene Bookhard - Dimoh
• Lea M Boriskin, LCSW
• Casey Boston
• Graciela Boyce, MSC.ED

• Clinical Social Worker in South Ozone Park, NY
• Providers in South Ozone Park, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; 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.