Emerson Jeffrey Boogaard, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN24215 Issued in FL

Practice address

11380 Bonita Beach Rd SE
Bonita Springs, FL 34135-5905

Phone

(239) 221-7402

NPI assigned

Jun 7, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Coast Florida P.a.

  • Dentist
  • Tampa, FL
  • NPI 1730287673
  NPD (past)
• Coast Florida P.a.

  • Dentist
  • North Fort Myers, FL
  • NPI 1871169250
  NPD (past)

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1265091870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 LANA CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339055694",
            "telephone_number": "801-857-1786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11380 BONITA BEACH RD SE",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341355905",
            "telephone_number": "239-221-7402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOGAARD",
        "first_name": "EMERSON",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-07",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN24215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonita Springs Chiropractic Corp
• Bonita Springs Edc Management LLC
• Bonita Springs Retirement Village, Inc.
• Bonita Springs Sports & Physical Therapy Center Inc
• Bonita Wellness Center
• Becky Arlene Boros, DC
• O'Malley Marie Bosanic, OD
• Botina Springs Medical Group
• Brain and Spine Consultants, Inc.
• Brain Function Clinic

• Dentist in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; 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.