Individual provider Active NPI

Mauritis Boon, M.D.

  • Otolaryngology Physician
  • Philadelphia, PA
National Provider Identifier
1225054810
Registry record updated Jul 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD-066864-L Issued in PA
Practice address
925 Chestnut St
6TH Floor
Philadelphia, PA 19107-4216
Phone
(215) 955-6760
Fax
(215) 923-4532
NPI assigned
Jul 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD-066864-L PA Primary

Addresses

Primary practice location

925 Chestnut St
6TH Floor
Philadelphia, PA 19107-4216

Mailing address

925 Chestnut St
6TH Floor
Philadelphia, PA 19107-4216

Other identifiers 2

IdentifierTypeStateIssuer
001843543MedicaidPA
8501904MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20041011000460 PA Practitioner - Otolaryngology 1850351248 Reassigns benefits to 1 organization
I20190530001634 NJ Practitioner - Otolaryngology 1850351248 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
State University of New York at Buffalo School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

925 Chestnut St
6TH Floor
Philadelphia, PA 19107-4216

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-066864-LPAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians of New Jersey, P.C. Otolaryngology CurrentSince Apr 10, 2019 Accepting new patients
Jefferson University Physicians Otolaryngology CurrentSince Jul 1, 2001 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

2211 Chapel Ave W
Cherry Hill, NJ 08002
Phone (856) 665-2017

443 Laurel Oak Rd
Ste 130
Voorhees, NJ 08043
Phone (856) 741-0122

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

1101 Chestnut St
Fl 16
Philadelphia, PA 19107
Phone (215) 955-6760

925 Chestnut St
Philadelphia, PA 19107
Phone (215) 955-5050

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 1

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": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406073600000",
    "number": "1225054810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT ST",
            "address_2": "6TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT ST",
            "address_2": "6TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074216",
            "telephone_number": "215-955-6760",
            "fax_number": "215-923-4532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOON",
        "first_name": "MAURITIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2014-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "PA",
            "license": "MD-066864-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001843543",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8501904",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.