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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: August 16, 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 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
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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 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.

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.

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 7 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.