JACOB BOISE
NPI 1164091120
Student in an Organized Health Care Education/Training Program in Atlanta, GA

Q: What is Jacob Boise's NPI number?

The NPI number for Jacob Boise is 1164091120. It was assigned to this individual provider in the NPPES registry on June 23, 2021.

Q: What is Jacob Boise'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 Jacob Boise was last updated on June 23, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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 June 23, 2021PECOS Enrolled

100 WOODRUFF CIR NE STE P375, ATLANTA, GA 30322(404) 727-5655 Get Directions Write a Review

NPPES record last updated: June 23, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Jacob Boise NPPES

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

JACOB BOISE (NPI 1164091120) is an individual student in an organized health care education/training program in Atlanta, Georgia and active in the NPI registry since June 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1164091120

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameJACOB BOISE

Location Address100 WOODRUFF CIR NE STE P375Atlanta, GA 30322-1020

Mailing Address100 Woodruff Cir Ne Ste P375Atlanta, GA 30322-1020 · (404) 727-5655

Phone(404) 727-5655

Sole ProprietorNo

Enumeration DateJune 23, 2021

NPPES CertifiedJune 21, 2021

✔ NPI 1164091120 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.

100 WOODRUFF CIR NE STE P375, Atlanta, GA 30322

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacob Boise 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.

CATHERINE YANG

Student in an Organized Health Care Education/Training Program