Individual provider Active NPI

Jeannette Epse Boluda

  • Home Health Aide
  • Takoma Park, MD
National Provider Identifier
1770936130
Registry record updated Feb 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AideTaxonomy code 374U00000X
License
HHA12205 Issued in DC
Practice address
6735 New Hampshire Ave
Apt 613
Takoma Park, MD 20912-4865
Phone
(240) 505-6246
NPI assigned
Jul 20, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Aide 374U00000X HHA12205 DC Primary

Addresses

Primary practice location

6735 New Hampshire Ave
Apt 613
Takoma Park, MD 20912-4865

Mailing address

8860 Piney Branch Rd
Apt 1608
Silver Spring, MD 20903-4865
Phone (240) 505-6246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
HHA12205DCMDHome Health Aide

NPI Registry JSON

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

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519344000000",
    "number": "1770936130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8860 PINEY BRANCH RD",
            "address_2": "APT 1608",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209034865",
            "telephone_number": "240-505-6246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6735 NEW HAMPSHIRE AVE",
            "address_2": "APT 613",
            "city": "TAKOMA PARK",
            "state": "MD",
            "postal_code": "209124865",
            "telephone_number": "240-505-6246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLUDA",
        "first_name": "JEANNETTE",
        "middle_name": "EPSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-20",
        "last_updated": "2018-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "DC",
            "license": "HHA12205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Takoma Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.