Grigorii Gennadiyouych Bouldo, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0116025455 Issued in VA

Practice address

40 Lambert St
Staunton, VA 24401-2446

Phone

(540) 885-3525

Fax

(540) 886-5935

NPI assigned

Jun 18, 2012

Last updated

Sep 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Carilion Healthcare CorporationGroup PAC ID 5890607253, 540 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health Care Home health agency, Staunton, VA, CCN 497646
• Interim Healthcare - Charlottesville Home health agency, Charlottesville, VA, CCN 497447
• Augusta Home Care, Home health agency, Fishersville, VA, CCN 497285
• Augusta Health Hospital, Fishersville, VA, CCN 490018
• Sentara RMH Medical Center Hospital, Harrisonburg, VA, CCN 490004

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gbouldo10040@direct.carilionclinic.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carilion Healthcare Corporation

  dba Bridgewater College Student Health Center

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1447206370
  Medicare reassignment Care Compare group NPD
• Carilion Medical Center

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1730123472
  Medicare reassignment NPD
• Carilion Healthcare Corporation

  • Durable Medical Equipment & Medical Supplies
  • Blacksburg, VA
  • NPI 1407667256
  NPD
• Carilion Medical Center

  dba Carilion Clinic - DME - Westlake

  • Durable Medical Equipment & Medical Supplies
  • Hardy, VA
  • NPI 1073324810
  NPD

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

• Amedisys Home Health of Virginia LLC

  dba Amedisys Home Health Care

  • Home Health Agency
  • Staunton, VA
  • NPI 1073794863
  Care Compare affiliation
• Augusta Health Care, Inc

  dba t/a Augusta Health

  • General Acute Care Hospital
  • Fishersville, VA
  • NPI 1053301127
  Care Compare affiliation
• Augusta Health Care, Inc

  dba Augusta Health Home Health

  • Home Health Agency
  • Fishersville, VA
  • NPI 1992771067
  Care Compare affiliation
• Haslup Enterprises, LTD.

  dba Interim HealthCare

  • Home Health Agency
  • Charlottesville, VA
  • NPI 1225068190
  Care Compare affiliation
• Sentara RMH Medical Center

  • General Acute Care Hospital
  • Harrisonburg, VA
  • NPI 1780694372
  Care Compare affiliation

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

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1912260787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 LAMBERT ST",
            "city": "STAUNTON",
            "state": "VA",
            "postal_code": "244012446",
            "telephone_number": "540-885-3525",
            "fax_number": "540-886-5935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDO",
        "first_name": "GRIGORII",
        "middle_name": "GENNADIYOUYCH",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-18",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116025455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Borja
• Demetri Antonio Boston, RPH
• Kimberly Ann Botkin, PTA
• Tammy Botkin, PT
• Cody Bottenfield, PHARMD
• Erica Lynne Bourdeau, NP
• Tricia Lynn Bowersox, PHARM.D
• John Edwin Boyles, DDS
• Asher Brand, MD
• Kenneth Hubert Brasfield, PHARM.D, BCPP

• Family Medicine Physician in Staunton, VA
• Providers in Staunton, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.

Verify at the official NPI Registry.