NPIMap

Individual provider Active NPI

Laura Ellen Boggs, DO

  • Internal Medicine Physician
  • Watertown, NY
National Provider Identifier
1013105949
Registry record updated May 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
250949 Issued in NY
Practice address
53-59 Public Square
Suite 301
Watertown, NY 13601-4034
Phone
(315) 782-2141
Fax
(315) 782-5123
NPI assigned
Oct 4, 2007
Last updated
May 19, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 250949 NY Primary

Addresses

Primary practice location

53-59 Public Square
Suite 301
Watertown, NY 13601-4034

Mailing address

53-59 Public Square
Suite 301
Watertown, NY 13601-2674
Phone (315) 782-2141

Other identifiers 1

IdentifierTypeStateIssuer
03128838MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090724000132 NY Practitioner - Internal Medicine 2961555859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia School of Osteopathic Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Watertown Internists PCGroup PAC ID 1355491606, 10 clinicians

Practice addresses (Care Compare)

53 -59 Public SQ
Suite 301
Watertown, NY 13601-2674
Phone (315) 782-2141

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
250949NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Watertown Internists PC Internal Medicine CurrentSince Jul 1, 2009 Accepting new patients
Samaritan Senior Village, Inc. Past Accepting new patients

Locations

53-59 Public Sq
Ste 301
Watertown, NY 13601
Phone (315) 782-2141

Interoperability endpoints

  • Direct secure messaging: drboggs@watertowninternists.medentdirect.com

Organizations & group practices 2

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

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305763200000",
    "number": "1013105949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53-59 PUBLIC SQUARE",
            "address_2": "SUITE 301",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012674",
            "telephone_number": "315-782-2141",
            "fax_number": "315-782-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53-59 PUBLIC SQUARE",
            "address_2": "SUITE 301",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014034",
            "telephone_number": "315-782-2141",
            "fax_number": "315-782-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGGS",
        "first_name": "LAURA",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-04",
        "last_updated": "2011-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "250949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03128838",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

Verify at the official NPI Registry.