Individual provider Active NPI

Dorothy C Boersma, MD, MPH

  • Family Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1174544530
Registry record updated Oct 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01028107 Issued in IN
Practice address
401 E 34TH St
Indianapolis, IN 46205-3754
Phone
(317) 926-1507
Fax
(317) 926-1508
NPI assigned
Jul 21, 2006
Last updated
Oct 24, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2016

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 01028107 IN Primary

Addresses

Primary practice location

401 E 34TH St
Indianapolis, IN 46205-3754

Mailing address

401 E 34TH St
Indianapolis, IN 46205-3754
Phone (317) 926-1507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20041203000645 IN Practitioner - Family Practice 1759276983 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01028107INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Raphael Health Center, Inc CurrentSince Jan 3, 2017 Accepting new patients
Raphael Health Center, Inc Family Medicine CurrentSince Jan 3, 2017 Accepting new patients
Open Door Health Services, Inc. Past Accepting new patients
Meridian Health Services Corp Past Accepting new patients

Locations

401 E 34th St
Indianapolis, IN 46205
Phone (317) 926-1507

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FDCGDD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477267200000",
    "number": "1174544530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E 34TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462053754",
            "telephone_number": "317-926-1507",
            "fax_number": "317-926-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E 34TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462053754",
            "telephone_number": "317-926-1507",
            "fax_number": "317-926-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOERSMA",
        "first_name": "DOROTHY",
        "middle_name": "C",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2016-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01028107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.