Individual provider Active NPI

Judith A. Boris, FNP

  • Family Nurse Practitioner
  • Washington Court House, OH
National Provider Identifier
1962453894
Registry record updated Dec 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN231793 NP06492 Issued in OH
Practice address
1510 Columbus Ave
Suite 230
Washington Court House, OH 43160-1899
Phone
(740) 333-3333
Fax
(740) 636-1196
NPI assigned
May 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN231793 NP06492 OH Primary

Addresses

Primary practice location

1510 Columbus Ave
Suite 230
Washington Court House, OH 43160-1899

Mailing address

1450 Columbus Ave
Suite 104
Washington Court House, OH 43160-3701
Phone (740) 333-2236

Other identifiers 1

IdentifierTypeStateIssuer
2254760MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240228004418 OH Order and Referring Only - Nurse Practitioner 0749243012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN231793 NP06492OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Dirk LLC PastSince May 29, 2011 Accepting new patients
FRS Counseling PastSince Mar 6, 2018 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387756800000",
    "number": "1962453894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 COLUMBUS AVE",
            "address_2": "SUITE 104",
            "city": "WASHINGTON COURT HOUSE",
            "state": "OH",
            "postal_code": "431603701",
            "telephone_number": "740-333-2236",
            "fax_number": "740-333-3881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 COLUMBUS AVE",
            "address_2": "SUITE 230",
            "city": "WASHINGTON COURT HOUSE",
            "state": "OH",
            "postal_code": "431601899",
            "telephone_number": "740-333-3333",
            "fax_number": "740-636-1196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORIS",
        "first_name": "JUDITH",
        "middle_name": "A.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2013-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "RN231793 NP06492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2254760",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington Court House, OH

Sources for this page

Verify at the official NPI Registry.