CMS-1500 Box 24J / 33a • NPI
1639541022
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LP0808X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health
Box 32 Service Location & ZIP+4
1809 W REDLANDS BLVD STE 103, REDLANDS, CA, 92373-8054
✓ 9-Digit EDI 837 ZIP+4 (92373-8054)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1639541022 (FADY BOULES) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1639541022)
Medicare Beneficiaries
128
Total Billed Services
842
Distinct CPT/HCPCS Codes
4
Medicare Allowed Total
$73,334.16
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
90792 | Psychiatric diagnostic evaluation with medical services | 12 |
99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 621 |
99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 194 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Abilify Maintena Aripiprazole | 56 | <11 |
| Alprazolam Alprazolam | 236 | 38 |
| Amitriptyline Hcl Amitriptyline Hcl | 82 | 11 |
| Aripiprazole Aripiprazole | 247 | 46 |
| Atomoxetine Hcl Atomoxetine Hcl | 27 | <11 |
| Benztropine Mesylate Benztropine Mesylate | 87 | 18 |
| Bupropion Hcl Bupropion Hcl | 91 | 25 |
| Bupropion Xl Bupropion Hcl | 173 | 42 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1639541022 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | FADY BOULES |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health NUCC Code: 363LP0808X (Nurse Practitioner, Psych/Mental Health) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 1809 W REDLANDS BLVD STE 103, REDLANDS, CA, 92373-8054 |
| Practice Telephone / Fax | Tel: (909) 707-6261 |
| Administrative Mailing Address | 18672 FLORIDA ST STE 201C, HUNTINGTON BEACH, CA, 92648-6088 |
| Enumeration & Last Sync | Enumerated: 2015-10-23 | CMS Record Updated: 2026-10-16 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LP0808X)
What Does Taxonomy Code 363LP0808X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LP0808X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (FADY BOULES)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363LF0000X — Nurse Practitioner, FamilyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family | State: CA | License: 95003306 | Primary: Secondary |
363LP0808X — Nurse Practitioner, Psych/Mental HealthPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health | State: CA | License: 95003306 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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