Active NPI
Joshua Paul Boldt, MD
- Pediatrics Physician
- Festus, MO
National Provider Identifier
1013992189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 009912
- Practice address
- 35 Goodwin Dr
Festus, MO 63028-4122 - Phone
- (636) 933-4141
- Fax
- (636) 931-7007
- NPI assigned
- Dec 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 009912 | MO | Primary |
Addresses
Primary practice location
35 Goodwin Dr
Festus, MO 63028-4122
Mailing address
35 Goodwin Dr
Festus, MO 63028-4122
Phone (636) 933-4141
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 207361403 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009912 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ccpartners LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Adolescent Medicine Physician
- Festus, MO
- NPI 1487857033
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695254400000",
"number": "1013992189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 GOODWIN DR",
"city": "FESTUS",
"state": "MO",
"postal_code": "630284122",
"telephone_number": "636-933-4141",
"fax_number": "636-931-7007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 GOODWIN DR",
"city": "FESTUS",
"state": "MO",
"postal_code": "630284122",
"telephone_number": "636-933-4141",
"fax_number": "636-931-7007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDT",
"first_name": "JOSHUA",
"middle_name": "PAUL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-13",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "009912",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207361403",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Festus, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.