Macie Maxfield Boden, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA14203 Issued in TX

Practice address

6410 Fannin St
Houston, TX 77030-3000

Phone

(713) 704-5223

NPI assigned

Feb 22, 2021

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Ut Physicians

  • Anesthesiology Physician
  • Houston, TX
  • NPI 1033157821

  Pediatrics

  Medicare reassignment NPD
• Ut Physicians

  dba UT Health Services

  • Health Educator
  • Houston, TX
  • NPI 1316534472
  NPD
• Bayshore Pediatrics

  • Pediatrics Physician
  • Pasadena, TX
  • NPI 1114133394
  NPD (past)

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

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677110400000",
    "number": "1083208920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6431 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "713-704-5223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770303000",
            "telephone_number": "713-704-5223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODEN",
        "first_name": "MACIE",
        "middle_name": "MAXFIELD",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-22",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA14203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS PA BOARD",
            "identifier": "PA14203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Riddhi Umesh Bodani, MD
• Boddie Wellness & Consulting Firm
• Krishna Boddu, M.D.
• Olasimbo Bode
• Tad Bodeman, LCSW
• Shanna Bodenhamer
• Carol Bodenheimer, M.D.
• Bodhi Counseling and Consulting PLLC
• Bodied Chiropractic Clinic
• Bodies in Balance

• Physician Assistant in Houston, TX
• Providers in Houston, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.