Mark J Boerner, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

M7206 Issued in ID

Practice address

111 W Main St Ste 200
Boise, ID 83702-7308

Phone

(208) 344-3220

Fax

(208) 344-0461

NPI assigned

May 31, 2005

Reactivated

Mar 31, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

OphthalmologyAlso: Plastic and Reconstructive Surgery

Education

University of Texas Medical School at San Antonio, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Idaho Eyelid and Facial Plastic Surgery PLLCGroup PAC ID 3375457906, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: idahoeyelidfacialplasticsurgery.markboerner@149618.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Idaho Eyelid & Facial Plastic Surgery , PLLC

  • Ophthalmology Physician
  • Boise, ID
  • NPI 1255401436
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1003819459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W MAIN ST",
            "address_2": "STE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027308",
            "telephone_number": "208-344-3220",
            "fax_number": "208-344-0461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W MAIN ST STE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027308",
            "telephone_number": "208-344-3220",
            "fax_number": "208-344-0461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOERNER",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M7206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180038677",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804243800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "J5164",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010002554",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "1317920001",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Body of a Champion Chiropractic, PC
• Body Wise Physical Therapy PLLC
• Kathryn West Boedeker, MS, LPC, NCC
• Jess Seymour Boeder, MS., CCC, SLP
• Kimberly Ann Boenig, PTA
• Brian Max Boesiger, M.D.
• Daniel Richard Boespflug, O.D.
• Taylor K Boettiger, MD
• Josie Boggs, LSWA-IC
• Jefferson Bohan, PHARM.D.

• Ophthalmology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Ophthalmology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.