Michelle Koren Boswell, PH.D., HSPP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20042452A Issued in IN

Practice address

4715 Viewridge Ave Ste 230
San Diego, CA 92123-1680

Phone

(800) 257-8715

NPI assigned

May 14, 2009

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Aims, LLC

  • Psychiatry Physician
  • Bremen, IN
  • NPI 1376072785

  Clinical

  Medicare reassignment NPD
• Valley Oaks Health Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lafayette, IN
  • NPI 1689629990
  Medicare reassignment NPD
• Valley Oaks Health Inc

  • Federally Qualified Health Center (FQHC)
  • Lafayette, IN
  • NPI 1134901135
  NPD

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

{
    "created_epoch": "1242259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447113600000",
    "number": "1649404948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10705 HENDRICKS PL",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463072926",
            "telephone_number": "219-688-4523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 VIEWRIDGE AVE STE 230",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231680",
            "telephone_number": "800-257-8715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSWELL",
        "first_name": "MICHELLE",
        "middle_name": "KOREN",
        "name_prefix": "Dr.",
        "credential": "PH.D., HSPP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-14",
        "last_updated": "2015-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042452A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201003430",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Boston Medical Group California, L.L.C.
• Gilbert Erich Boswell, M.D.
• Hannah Boswell
• James Darnell Boswell
• Lanny L Boswell, PHD
• Nidia Boswell
• Sara Lynn Boswell, PH.D.
• Bosworth, Inc a Dental Corporation
• Yolanda Botani
• Michaela Nicole Botello, B.A.

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; 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.