Mary Rose Boehm MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME 88288 Issued in FL

Legal business name

MARY ROSE BOEHM MD PA

Practice address

200 E Highland Ave
Suite #2
Clermont, FL 34711-2582

Phone

(352) 242-1430

Fax

(352) 242-1452

NPI assigned

Sep 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mary Rose Boehm, MDNPI 1770674715

Title

President

Phone

(352) 242-1430

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

Mary Rose Boehm MD PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mary Rose Boehm MD PA

  • Primary Care Clinic/Center
  • Clermont, FL
  • NPI 1972708162
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Rose Boehm, MD

  • Internal Medicine Physician
  • Clermont, FL
  • NPI 1770674715
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053402156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 E HIGHWAY 50",
            "address_2": "BOX 304",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347113164",
            "telephone_number": "352-242-1430",
            "fax_number": "352-242-1452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E HIGHLAND AVE",
            "address_2": "SUITE #2",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112582",
            "telephone_number": "352-242-1430",
            "fax_number": "352-242-1452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY ROSE BOEHM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOEHM",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-242-1430",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 88288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7042549",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SCHIELD",
            "identifier": "81213",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Martinez-Harter
• Adriana Martinez
• Alec John Martinez, DPT
• Stephanie Martinez
• Amanda Marie Marty
• Mary Rose Boehm MD PA
• Eric Mason, PA
• Kaydee Mae Matherly, RBT
• Anish Mathew, RPH
• Thomas Sunil Mathew, MD

• Internal Medicine Physician in Clermont, FL
• Providers in Clermont, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.