Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

JOSEPH ROBERT BOULTER DMD
NPI 1053381632
Dentist - General Practice in Jacksonville, FL

Q: What is Joseph Boulter's NPI number?

The NPI number for Joseph Boulter is 1053381632. It was assigned to this individual provider in the NPPES registry on January 25, 2006.

Q: What is Joseph Boulter's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: Is Joseph Boulter enrolled in Medicare?

No. Joseph Boulter has opted out of Medicare through April 21, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Joseph Boulter was last updated on July 13, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since January 25, 2006Opted out of Medicare · through Apr 21, 2027

8823 GOODBYS EXECUTIVE DR, JACKSONVILLE, FL 32217(904) 731-0432(904) 731-5755 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Joseph Robert Boulter Dmd NPPES

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

JOSEPH ROBERT BOULTER DMD (NPI 1053381632) is an individual general practice provider in Jacksonville, Florida, licensed in Florida (10715) and active in the NPI registry since January 2006. He has opted out of Medicare through April 21, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1053381632

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameJOSEPH ROBERT BOULTERCredential: DMD

Location Address8823 GOODBYS EXECUTIVE DRJacksonville, FL 32217

Mailing Address8823 Goodbys Executive DrJacksonville, FL 32217 · (904) 731-0432 · Fax (904) 731-5755

Phone(904) 731-0432

Fax(904) 731-5755

Sole ProprietorNo

Enumeration DateJanuary 25, 2006

Last NPPES UpdateJuly 13, 2026

✔ NPI 1053381632 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Licenses✔ Licensed in FL · 10715✔ Licensed in NC · 5542

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

8823 GOODBYS EXECUTIVE DR, Jacksonville, FL 32217

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

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Opted out of Medicare

Joseph Robert Boulter Dmd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 21, 2015 through April 21, 2027.

Opt-Out Effective DateApril 21, 2015

Opt-Out In Effect ThroughApril 21, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32217 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$70.04 typical visit price

range $17.57 – $139.16

Typical copayment $17.51 (range $4.39 – $34.79)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

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

JOSEPH R. BOULTER, D.M.D., M.A.G.D., P.A.

Dentist (General Practice)