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SHADY BOULES NP
NPI 1497123517
Nurse Practitioner - Psychiatric/Mental Health in Riverside, CA

Active since September 04, 2015PECOS EnrolledAccepts Medicare Assignment
16282 SKYRIDGE DR, RIVERSIDE, CA 92503(951) 722-0802 Get Directions Write a Review

NPPES record last updated: December 25, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Shady Boules Np NPPES

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

SHADY BOULES NP (NPI 1497123517) is an individual psychiatric/mental health provider in Riverside, California, licensed in California (95037846) and active in the NPI registry since September 2015. He is enrolled in Medicare PECOS, maintains a secondary practice location in Newport Beach, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1497123517
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameSHADY BOULESCredential: NP
Location Address16282 SKYRIDGE DRRiverside, CA 92503-0562
Mailing Address16282 Skyridge DrRiverside, CA 92503-0562 · (951) 722-0802
Phone(951) 722-0802
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateSeptember 4, 2015
Last NPPES UpdateDecember 25, 2025
NPPES CertifiedDecember 25, 2025
✔ NPI 1497123517 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in CA · 95037846
16282 SKYRIDGE DR, Riverside, CA 92503
Open in Google Maps ↗

Secondary Practice Location 1

Location 14695 MacArthur Ct Ste 1100Newport Beach, CA 92660-1866 · Phone (949) 293-3440

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shady Boules Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7113403122
PECOS Enrollment IDI20260109000519
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Shady Boules reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Kamel L. Kamel, M.D, Inc
23 mi
Psychiatry
5405 ALTON PKWY STE 5A
Irvine, CA 92604
  • Reassigned Medicare billing, California enrollment
  • 3 clinicians in this Medicare group
NPI 1154508414 (626) 336-5061
Ehab Yacoub MD Inc.
47 mi
Child & Adolescent Psychiatry
1225 W 190TH ST STE 280
Gardena, CA 90248
  • Reassigned Medicare billing, California enrollment
  • 375 clinicians in this Medicare group
NPI 1417373713 (310) 515-8113

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92503 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
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$104.64 typical visit price
range $19.37 – $146.42
Typical copayment $26.16 (range $4.84 – $36.60)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shady Boules's NPI number?

The NPI number for Shady Boules is 1497123517. It was assigned to this individual provider in the NPPES registry on September 4, 2015.

Where is Shady Boules located?

Shady Boules practices at 16282 Skyridge Dr, Riverside, CA 92503. The listed phone number is (951) 722-0802.

What is Shady Boules's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Shady Boules enrolled in Medicare?

Yes. Shady Boules is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Shady Boules's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shady Boules reassigns Medicare benefits to 2 organizations: Kamel L. Kamel, M.D, Inc (Irvine, CA) and Ehab Yacoub MD Inc. (Gardena, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shady Boules's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Shady Boules was last updated on December 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.