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JACQUELINE ANNE BOULRIS PA-C
NPI 1639937154
Physician Assistant - Medical in Reston, VA

Active since March 11, 2024PECOS Enrolled
1860 TOWN CENTER DR STE 240, RESTON, VA 20190(703) 796-1986 Get Directions Write a Review

NPPES record last updated: February 21, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jacqueline Anne Boulris Pa-c NPPES

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

JACQUELINE ANNE BOULRIS PA-C (NPI 1639937154) is an individual medical provider in Reston, Virginia, licensed in Virginia (0110009803) and active in the NPI registry since March 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1639937154
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameJACQUELINE ANNE BOULRISCredential: PA-C
Location Address1860 TOWN CENTER DR STE 240Reston, VA 20190-5899
Mailing Address1860 Town Center Dr Ste 240Reston, VA 20190-5899 · (703) 796-1986
Phone(703) 796-1986
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateMarch 11, 2024
Last NPPES UpdateFebruary 21, 2025
NPPES CertifiedFebruary 21, 2025
✔ NPI 1639937154 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in VA · 0110009803
1860 TOWN CENTER DR STE 240, Reston, VA 20190
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Other Names 1

Other Name (5)Jackie Boulris Pa-c

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqueline Anne Boulris Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID143796227
PECOS Enrollment IDI20260416000809
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 4

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

ALICIA STRINGHAM PA-C
Obstetrics & Gynecology
1860 TOWN CENTER DR STE 240
RESTON, VA 20190
Fairfax County (703) 796-1986
MS. SAMANTHA MAJOR FRAZIER PA-C
Physician Assistant
1860 TOWN CENTER DR STE 240
RESTON, VA 20190
Fairfax County (703) 796-1986
AGATA ALICJA GREER PA
Physician Assistant (Medical)
1860 TOWN CENTER DR STE 240
RESTON, VA 20190
Fairfax County (703) 796-1986
GAZELLE CLINICAL SYSTEM, INC.
Clinical Medical Laboratory
1860 TOWN CENTER DR STE 240
RESTON, VA 20190
Fairfax County (919) 699-6469

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 Jacqueline Boulris's NPI number?

The NPI number for Jacqueline Boulris is 1639937154. It was assigned to this individual provider in the NPPES registry on March 11, 2024. The provider is also known as Jackie Boulris Pa-C.

Where is Jacqueline Boulris located?

Jacqueline Boulris practices at 1860 Town Center Dr Ste 240, Reston, VA 20190. The listed phone number is (703) 796-1986.

What is Jacqueline Boulris's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Jacqueline Boulris enrolled in Medicare?

Yes. Jacqueline Boulris is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacqueline Boulris was last updated on February 21, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.