Nicole Christine Boucuvalas, CNP
Individual provider Active NPI Family Nurse Practitioner · Springboro, OH
NPI 1851843668 · NPPES record last updated Nov 20, 2020
Key facts
- NPI
- 1851843668
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- APRN.CNP.020071 (OH)
- Practice address
- 825 N Main St Ste 130
Springboro, OH 45066-2100 - Phone
- (937) 433-5309
- Fax
- (937) 424-3650
- NPI assigned
- Oct 27, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kettering Independent Medical Group Inc
Practice addresses (Care Compare)
3535 Pentagon Blvd
Beavercreek, OH 45431-1705
3535 Pentagon Park Blvd
Suite 400
Dayton, OH 45431-1705
Phone (937) 490-2264
3737 Southern Blvd
Kettering, OH 45429-1285
4403 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 433-5309
4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7751
Hospital & facility affiliations
- Kettering Health Dayton
- Soin Medical Center
- Kettering Health Main Campus
- Kettering Health Greene Memorial
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.34 of 100
- Quality
- 63.67
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.14
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161118002139 | OH | Practitioner - Nurse Practitioner | 6305125121 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN.CNP.020071 | OH | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dayton Osteopathic Hospital | Current | Accepting new patients | |
| Dayton Osteopathic Hospital | Current |
Accepting new patients | |
| Dayton Osteopathic Hospital | Current |
Accepting new patients | |
| Kettering Independent Medical Group Inc | Current |
Accepting new patients |
Locations
7740 Washington Village Dr
Ste 130
Dayton, OH 45459
Phone (513) 932-4891
6438 Wilmington Pike
Ste 220
Dayton, OH 45459
Phone (937) 433-1336
165 S Edwin C Moses Blvd
Dayton, OH 45402
Phone (937) 396-8150
1989 Miamisburg Centerville Rd
Ste 304
Dayton, OH 45459
Phone (937) 223-6837
450B Washington Jackson Rd
Ste 111
Eaton, OH 45320
Phone (937) 558-0200
1250 W National Rd
Ste 100A
Englewood, OH 45315
Phone (937) 558-0200
8701 Troy Pike
Ste 40A
Huber Heights, OH 45424
Phone (937) 233-5084
4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910
1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306
825 N Main St
Ste 130
Springboro, OH 45066
Phone (937) 401-7583
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APRN.CNP.020071 | OH | Yes |
Addresses
Primary practice location
825 N Main St Ste 130
Springboro, OH 45066-2100
Mailing address
825 N Main St Ste 130
Springboro, OH 45066-2100
Phone (937) 433-5309
Other practice location 1
165 Edwin C. moses Blvd
Dayton, OH 45402-8472
Phone (937) 558-0200
Other practice location 2
1989 Miamisburg Centerville Rd Ste 304
Dayton, OH 45459-3823
Phone (937) 558-0200
Other practice location 3
450B Washington Jackson Rd Ste 111
Eaton, OH 45320-7601
Phone (937) 558-0200
Other practice location 4
1250 W National Rd Ste 100A
Englewood, OH 45315-9505
Phone (937) 558-0200
Other practice location 5
8701 Old Troy Pike Ste 40A
Huber Heights, OH 45424-1066
Phone (937) 558-0200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0190775 | Medicaid | OH | |
| H522020 | Other | OH | MEDICARE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nboucuvalas565490@direct.ketteringhealth.org | ||
| FHIR URL | https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/ |
Other providers in Springboro, OH
- Kevin Brett Biltz
- Maegan Birk
- F Ward Blair
- Karen Blake
- Kassandra Danielle Bond
- William Ralph Box
- Heather Nicole Brahm
- Theresa Braun
- Brickner Chiropractic Health Center, Inc.
- Dennis Scott Brickner
All providers in Springboro, OH · Family Nurse Practitioner in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.