Andrew Kamal Boulos, M.D.

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

License

S4733 Issued in TX

Practice address

4100 W University Dr
Prosper, TX 75078-3123

Phone

(945) 204-4100

Fax

(682) 885-1903

NPI assigned

May 18, 2014

Last updated

Aug 20, 2024By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aboulos216349@cookchildrens.direct-ci.com

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.

• Cook Children's Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1750369203
  Medicare reassignment NPD
• Pediatric Emergency Medicine Group LLP

  • Emergency Medicine Physician
  • Plano, TX
  • NPI 1629448535
  Medicare reassignment NPD
• Texas Medicine Resources, LLP

  • Emergency Medicine Physician
  • Fort Worth, TX
  • NPI 1376581900
  Medicare reassignment NPD
• Cook Children's Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1083472062
  NPD
• Cook Children's Physician Network

  dba Cook Children's Physician Network - West

  • Pediatrics Physician
  • Lubbock, TX
  • NPI 1881399426
  NPD
• Complex Care Medical Services Corporation

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1013256098
  NPD (past)
• Cook Children's Medical Center

  dba Cook Children's Behavioral Health

  • Clinical Child & Adolescent Psychologist
  • Fort Worth, TX
  • NPI 1942509963
  NPD (past)

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

{
    "created_epoch": "1400371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1922419407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-6483",
            "fax_number": "682-885-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 W UNIVERSITY DR",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750783123",
            "telephone_number": "945-204-4100",
            "fax_number": "682-885-1903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULOS",
        "first_name": "ANDREW",
        "middle_name": "KAMAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-18",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "TX",
            "license": "S4733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aboulos216349@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "4100 W University Dr",
            "city": "Prosper",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750783123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Trevor Paul Bodine, DDS MS
• Trent Shakespear Boehm, DPM
• Anjelica Boley, MS
• Michael Francis Bonislawsi, RN
• Boom Pediatric Therapy
• Tiffany Boulware, DPT
• Kanika Alake Bowen-Jallow, MD
• Jacquelyn Bowen
• Kristen Kaye Bowling
• Jalisa Laray Boyd, RN

• Pediatric Emergency Medicine (Pediatrics) Physician in Prosper, TX
• Providers in Prosper, TX by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.