Alan D Boom, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

019703 Issued in TN

Practice address

1211 Union Ave
Suite 300
Memphis, TN 38104-6638

Phone

(901) 725-7551

Fax

(901) 725-9721

NPI assigned

Dec 2, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Duckworth Laboratories Inc.

  • Anatomic Pathology Physician
  • Memphis, TN
  • NPI 1205173770
  NPD
• Methodist Surgery Center Germantown LP

  • Ambulatory Surgical Clinic/Center
  • Germantown, TN
  • NPI 1053381236
  NPD
• Pathology Specialists of Memphis PC

  • Clinical Pathology Physician
  • Memphis, TN
  • NPI 1437817491
  NPD
• Duckworth Pathology Group, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Memphis, TN
  • NPI 1154305779
  NPD (past)

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198713600000",
    "number": "1265416333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE",
            "address_2": "SUITE 300",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046638",
            "telephone_number": "901-725-7551",
            "fax_number": "901-725-9721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE",
            "address_2": "SUITE 300",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046638",
            "telephone_number": "901-725-7551",
            "fax_number": "901-725-9721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOM",
        "first_name": "ALAN",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2007-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TN",
            "license": "019703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3053894",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Bontemps
• Blythe Booker, NP
• Tracee L Booker, PHARMD
• Zorana J. Booker, PHARMD
• Judith S Bookman, LCSW
• Emily Boone, RN
• James Earle Boone, MD
• Kimberly Afton Boone, MD
• Laurie Boone, RPH
• Frederick A Boop, MD

• Anatomic Pathology & Clinical Pathology Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Anatomic Pathology & Clinical Pathology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; 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.