MR. CARL BOULOS M.D.
NPI 1023674397
Student in an Organized Health Care Education/Training Program in Cleveland, OH

Q: What is Carl Boulos's NPI number?

The NPI number for Carl Boulos is 1023674397. It was assigned to this individual provider in the NPPES registry on May 13, 2019.

Q: What is Carl Boulos's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Carl Boulos was last updated on May 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 13, 2019PECOS Enrolled

9500 EUCLID AVE # JJ24, CLEVELAND, OH 44195(216) 444-2200 Get Directions Write a Review

NPPES record last updated: May 17, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 17, 2023, Dec 31, 2019, May 29, 2019 and 1 more (4 updates tracked since 2019).

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About Mr. Carl Boulos M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. CARL BOULOS M.D. (NPI 1023674397) is an individual student in an organized health care education/training program in Cleveland, Ohio and active in the NPI registry since May 2019. He is enrolled in Medicare PECOS and maintains a secondary practice location in Detroit.

NPPES Registry Identity

NPI1023674397

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameMR. CARL BOULOSCredential: M.D.

Location Address9500 EUCLID AVE # JJ24Cleveland, OH 44195-0001

Mailing AddressCleveland Clinic 9500 Euclid Avenue/jj24Cleveland, OH 44195-0001 · (216) 444-2200

Phone(216) 444-2200

Sole ProprietorNo

Enumeration DateMay 13, 2019

Last NPPES UpdateMay 17, 20234 updates tracked since enumeration

NPPES CertifiedApril 4, 2023

✔ NPI 1023674397 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

9500 EUCLID AVE # JJ24, Cleveland, OH 44195

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Secondary Practice Location 1

Location 13990 John RDetroit, MI 48201 · Phone (313) 745-7233 · Fax (313) 993-3889

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Carl Boulos M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. BRANDY LEE SWEENEY DO

Student in an Organized Health Care Education/Training Program