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SAMAR MARIE BOULOS D.O.
NPI 1689067829
Pediatrics in Lansing, MI

Active since March 12, 2015PECOS Enrolled
1717 N HIGH ST, LANSING, MI 48906(517) 371-1700(517) 371-4245 Get Directions Write a Review

NPPES record last updated: April 22, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Apr 22, 2022, Dec 7, 2018 (2 updates tracked since 2018).

About Samar Marie Boulos D.o. NPPES

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

SAMAR MARIE BOULOS D.O. (NPI 1689067829) is an individual pediatrics provider in Lansing, Michigan, licensed in Michigan (5101024418) and active in the NPI registry since March 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1689067829
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameSAMAR MARIE BOULOSCredential: D.O.
Location Address1717 N HIGH STLansing, MI 48906-4597
Mailing Address1717 N High StLansing, MI 48906-4597 · (517) 371-1700 · Fax (517) 371-4245
Phone(517) 371-1700
Fax(517) 371-4245
Sole ProprietorNo
Enumeration DateMarch 12, 2015
Last NPPES UpdateApril 22, 20222 updates tracked since enumeration
NPPES CertifiedApril 22, 2022
✔ NPI 1689067829 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in MI · 5101024418
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
1717 N HIGH ST, Lansing, MI 48906
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Priority Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samar Marie Boulos D.o. 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.

Medicare Billing Reassignment

Medicare enrollment records show Samar Boulos reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Catholic Charities Of Ingham, Eaton & Clinton Counties
Same address
General Practice
1717 N HIGH ST
Lansing, MI 48906
  • Reassigned Medicare billing, Michigan enrollment
  • Medicare enrollment name: Cristo Rey Community Center
  • 18 clinicians in this Medicare group
NPI 1407800931 (517) 371-1700

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 48906 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
$84.74 typical visit price
range $54.34 – $166.68
Typical copayment $21.18 (range $13.58 – $41.67)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.09 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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.

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.

MISS MALARY JEAN THORSBY
Student in an Organized Health Care Education/Training Program
1717 N HIGH ST
LANSING, MI 48906
Ingham County (517) 372-4700
MADISON BOYLE
Counselor (Addiction (Substance Use Disorder))
1717 N HIGH ST
LANSING, MI 48906
Ingham County (517) 372-4700
ANNA MARIE SEVENSKI
Social Worker
1717 N HIGH ST
LANSING, MI 48906
Ingham County (517) 372-4700
MRS. STEPHANIE LYNN SCHULTZ NP
Nurse Practitioner (Family)
1717 N HIGH ST
LANSING, MI 48906
Ingham County (517) 253-8243
ROBERT POWELL LMSW
Social Worker
1717 N HIGH ST
LANSING, MI 48906
Ingham County (517) 372-4700
MR. JALEN SCHAFER
Social Worker
1717 N HIGH ST
LANSING, MI 48906
Ingham County (517) 372-4700
ROSA CASTANON
Social Worker
1717 N HIGH ST
LANSING, MI 48906
Ingham County (517) 372-4700
ALEXIS DAUGHERTY
Social Worker (Clinical)
1717 N HIGH ST
LANSING, MI 48906
Ingham County (517) 372-4700

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 Samar Boulos's NPI number?

The NPI number for Samar Boulos is 1689067829. It was assigned to this individual provider in the NPPES registry on March 12, 2015.

Where is Samar Boulos located?

Samar Boulos practices at 1717 N High St, Lansing, MI 48906. The listed phone number is (517) 371-1700.

What is Samar Boulos's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Samar Boulos enrolled in Medicare?

Yes. Samar Boulos is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Samar Boulos's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samar Boulos reassigns Medicare benefits to Catholic Charities Of Ingham, Eaton & Clinton Counties (Lansing, MI). The 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 Samar Boulos's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Samar Boulos accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company and Priority Health list Samar Boulos as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Samar Boulos was last updated on April 22, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.