Brian Clark Boese, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501018260 Issued in MI

Practice address

10415 Grand River Rd Ste 300
Brighton, MI 48116-6533

Phone

(810) 229-6140

Fax

(810) 229-6145

NPI assigned

Feb 8, 2012

Last updated

Mar 17, 2018By 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 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Physical Therapy Services PC

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  NPD (past)
• Physical Therapy Services PC

  • Physical Therapist
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  • NPI 1780949701
  NPD (past)

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

{
    "created_epoch": "1328659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1922370857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "810-229-6140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10415 GRAND RIVER RD STE 300",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481166533",
            "telephone_number": "810-229-6140",
            "fax_number": "810-229-6145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4040 NE Fremont St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972121952",
            "country_code": "US",
            "telephone_number": "503-493-4463",
            "fax_number": "503-493-4348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOESE",
        "first_name": "BRIAN",
        "middle_name": "CLARK",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-08",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "004883",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "60259",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501018260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01740336",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500697800",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L&I",
            "identifier": "0349714",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• BJC Foot and Ankle PC (Brighton Foot and Ankle)
• Elizabeth Jean Black, M.S.W.
• Megan Rose Blades
• Jacqueline Blair
• Blue Lotus Therapy Services LLC
• Samantha Boggs, RBT
• Kevin John Bohnsack, M.D.
• Melanie Bondoc, MD
• Kira Boneff, MS
• James Vincent Bonifer

• Physical Therapist in Brighton, MI
• Providers in Brighton, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.