Individual provider Active NPI

Sunni S. Boren, M.D.

  • Obstetrics & Gynecology Physician
  • Tyler, TX
National Provider Identifier
1164586509
Registry record updated Apr 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
L6801 Issued in TX
Practice address
2017 Rickety LN
Tyler, TX 75703-1706
Phone
(903) 533-8811
Fax
(903) 593-5511
NPI assigned
Dec 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X L6801 TX Primary

Addresses

Primary practice location

2017 Rickety LN
Tyler, TX 75703-1706

Mailing address

2017 Rickety LN
Tyler, TX 75703-1706
Phone (903) 533-8811

Other identifiers 1

IdentifierTypeStateIssuer
171414902MedicaidTX

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040907000930 TX Practitioner - Obstetrics/Gynecology 4880660570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Texas a & M University System, HSC, College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 590-5611

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2025 Accepting new patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2025 Accepting new patients
Tyler Regional Hospital LLC Past Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

700 Olympic Plaza Cir
Ste 418
Tyler, TX 75701
Phone (903) 533-8811

2017 Rickety Ln
Tyler, TX 75703
Phone (903) 533-8811

Interoperability endpoints

  • Direct secure messaging: sboren355706@ahs.direct-ci.com

Organizations & group practices 3

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": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334707200000",
    "number": "1164586509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 RICKETY LN",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031706",
            "telephone_number": "903-533-8811",
            "fax_number": "903-593-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 RICKETY LN",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031706",
            "telephone_number": "903-533-8811",
            "fax_number": "903-593-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOREN",
        "first_name": "SUNNI",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2012-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "L6801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171414902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.