Individual provider Active NPI

Jordan Boss

  • Certified Registered Nurse Anesthetist
  • Millbury, OH
National Provider Identifier
1841929569
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
143781 Issued in OH
Practice address
23251 W Moline Martin Rd
Millbury, OH 43447-9522
Phone
(419) 265-1813
NPI assigned
Jun 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 432068 OH
Certified Registered Nurse Anesthetist 367500000X 0020600 OH
Certified Registered Nurse Anesthetist 367500000X 143781 OH Primary

Addresses

Primary practice location

23251 W Moline Martin Rd
Millbury, OH 43447-9522

Mailing address

23251 W Moline Martin Rd
Millbury, OH 43447-9522
Phone (419) 265-1813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221122003545 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 4789052762 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
432068OHMDRegistered Nurse
0020600OHMDCertified Registered Nurse Anesthetist
143781OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Nov 1, 2022 Accepting new patients
Promedica Central Physicians CurrentSince Nov 1, 2022 Accepting new patients

Locations

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1841929569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23251 W MOLINE MARTIN RD",
            "city": "MILLBURY",
            "state": "OH",
            "postal_code": "434479522",
            "telephone_number": "419-265-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23251 W MOLINE MARTIN RD",
            "city": "MILLBURY",
            "state": "OH",
            "postal_code": "434479522",
            "telephone_number": "419-265-1813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSS",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "432068",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "0020600",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "143781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millbury, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.