NPIMap

Individual provider Active NPI

Boomi Nathan, MD

  • Family Medicine Physician
  • Cordova, TN
National Provider Identifier
1063540615
Registry record updated Feb 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-5585 Issued in AR
Practice address
8366 Trondheim Dr
Cordova, TN 38018-4376
Phone
(901) 428-0694
Fax
(901) 755-0559
NPI assigned
Mar 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E-5585 AR Primary

Addresses

Primary practice location

8366 Trondheim Dr
Cordova, TN 38018-4376

Mailing address

8366 Trondheim Dr
Cordova, TN 38018-4376
Phone (901) 428-0694

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20080929000750 AR Practitioner - Emergency Medicine 7315014511 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RH Arkansas Emergency Medicine PLLCGroup PAC ID 5395285571, 20 clinicians
WH Services Arkansas, LLCGroup PAC ID 3072045897, 22 clinicians

Practice addresses (Care Compare)

1520 N Division St
Blytheville, AR 72315-1448
Phone (870) 838-7333

1601 New Castle Rd
Forrest City, AR 72335-2218
Phone (469) 364-3333

Hospital & facility affiliations

  • Great River Medical Center Hospital, Blytheville, AR, CCN 040069
  • Forrest City Medical Center Hospital, Forrest City, AR, CCN 040019

Merit-based Incentive Payment System (MIPS)

Final score
91.6 of 100Reported as group
Quality
82.11
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
East Arkansas Emergency Physicians, PLLC CurrentSince Jul 1, 2013 Accepting new patients
WH Services Arkansas, LLC CurrentSince Oct 5, 2024 Accepting new patients
RH Arkansas Emergency Medicine, PLLC CurrentSince Jul 1, 2024 Accepting new patients
Forrest City Emergency Physicians PLLC Current Accepting new patients
East Arkansas Emergency Physicians, PLLC CurrentSince Jul 1, 2013 Accepting new patients
East Arkansas Emergency Physicians, PLLC Current Accepting new patients
Forrest City Emergency Physicians, PLLC CurrentSince Dec 1, 2009 Accepting new patients
West Lee Emergency Physicians Past Accepting new patients
St Francis Emergency Group LLC Past Accepting new patients
Genesis Emergency Medicine Services LLC Past Accepting new patients
North Division Street Emergency Physicians PastSince Oct 1, 2011 Accepting new patients

Locations

1520 N Division St
Blytheville, AR 72315
Phone (870) 838-7300

1601 New Castle Rd
Forrest City, AR 72335
Phone (870) 261-0000

611 W Lee Ave
Osceola, AR 72370
Phone (870) 563-7000

900 W Kingshighway
Paragould, AR 72450
Phone (870) 239-7000

Interoperability endpoints

  • Direct secure messaging: bnathan@yourcarecommunity.org

Organizations & group practices 11

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.

Hospital & facility affiliations 2

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": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234828800000",
    "number": "1063540615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8366 TRONDHEIM DR",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380184376",
            "telephone_number": "901-428-0694",
            "fax_number": "901-755-0559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8366 TRONDHEIM DR",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380184376",
            "telephone_number": "901-428-0694",
            "fax_number": "901-755-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NATHAN",
        "first_name": "BOOMI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2009-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-5585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

Verify at the official NPI Registry.