NPIMap

Individual provider Active NPI

Jerry Joe Boley, M.D.

  • Cardiovascular Disease Physician
  • Celina, OH
National Provider Identifier
1962465435
Registry record updated Mar 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
35070190B Issued in OH
Practice address
4112 Monroe Rd
Celina, OH 45828-9250
Phone
(614) 580-8563
NPI assigned
Apr 7, 2006
Last updated
Mar 11, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 35070190B OH Primary

Addresses

Primary practice location

4112 Monroe Rd
Celina, OH 45828-9250

Mailing address

4112 Monroe Rd
Celina, OH 45828-9250
Phone (614) 580-8563

Other identifiers 8

IdentifierTypeStateIssuer
289254OtherBLACK LUNG
1330778OtherCIGNA
060038975OtherOHRAILROAD MEDICARE
12723OtherNATIONWIDE
0307108MedicaidOH
060038975OtherRAILROAD MEDICARE
0000000014726OtherANTHEM BCBS
2500965OtherUNITED HEALTHCARE OF OHIO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080809000150 OH Practitioner - Cardiovascular Disease (Cardiology) 0244304145 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Johns Hopkins University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4112 Monroe Rd
Celina, OH 45822-9250
Phone (567) 890-9000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
23.96 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
79.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35070190BOHMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Joint Operating Company Past Accepting new patients
Columbus Cardiology Consultants, Inc. Cardiovascular Disease Past Accepting new patients

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394496000000",
    "number": "1962465435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4112 MONROE RD",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458289250",
            "telephone_number": "614-580-8563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 MONROE RD",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458289250",
            "telephone_number": "614-580-8563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLEY",
        "first_name": "JERRY",
        "middle_name": "JOE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-07",
        "last_updated": "2014-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35070190B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "289254",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1330778",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "060038975",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONWIDE",
            "identifier": "12723",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0307108",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "060038975",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "0000000014726",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE OF OHIO",
            "identifier": "2500965",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Celina, OH

Sources for this page

Verify at the official NPI Registry.