Active NPI
Kelsey Boudjalis
- Advanced Practice Midwife
- Ann Arbor, MI
National Provider Identifier
1639911597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- Practice address
- 4200 Whitehall Dr Ste 350
Ann Arbor, MI 48105-9694 - Phone
- (734) 572-9600
- Fax
- (734) 572-9600
- NPI assigned
- Jun 11, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | Primary |
Addresses
Primary practice location
4200 Whitehall Dr Ste 350
Ann Arbor, MI 48105-9694
Mailing address
24 Frank Lloyd Wright Dr Ste J2000
Ann Arbor, MI 48105-9484
Phone (734) 747-6766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Nurse Midwife (CNM)
- Education
- University of Michigan Medical School, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105-9484
PO Box
Suite 778964
Chicago, IL 60677-0853
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iha Health Services Corporation | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba IHA Canton Obstetrics and Gynecology
- Obstetrics & Gynecology Physician
- Canton, MI
- NPI 1457408965
-
dba IHA Milan Primary Care
- Family Medicine Physician
- Milan, MI
- NPI 1467509067
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785196800000",
"number": "1639911597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 FRANK LLOYD WRIGHT DR STE J2000",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481059484",
"telephone_number": "734-747-6766",
"fax_number": "734-222-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 WHITEHALL DR STE 350",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481059694",
"telephone_number": "734-572-9600",
"fax_number": "734-572-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDJALIS",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-11",
"last_updated": "2026-07-28",
"certification_date": "2026-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; 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.