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Individual provider Active NPI

Dominique Boudreau Boadwine, MD

  • Obstetrics & Gynecology Physician
  • Omaha, NE
National Provider Identifier
1265956908
Registry record updated Aug 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
8080 Issued in NE
Practice address
7710 Mercy Rd Ste 602
Omaha, NE 68124-2371
Phone
(402) 280-4438
NPI assigned
Aug 2, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Obstetrics & Gynecology Physician 207V00000X 8080 NE Primary

Addresses

Primary practice location

7710 Mercy Rd Ste 602
Omaha, NE 68124-2371

Mailing address

7710 Mercy Rd Ste 602
Omaha, NE 68124-2371

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210927001851 SD Practitioner - Obstetrics/Gynecology 5597162008 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1001 E 21St St
Suite 401
Sioux Falls, SD 57105-1017
Phone (605) 322-8920

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

1600 S Highline Ave
Sioux Falls, SD 57110-1008

1600 S Highline Ave
Suite 310
Sioux Falls, SD 57110-1007
Phone (605) 322-7600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8080NEMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Sep 1, 2021 Accepting new patients
Avera McKennan Obstetrics & Gynecology CurrentSince Sep 1, 2021 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan Past Accepting new patients

Locations

1417 S Cliff Ave
Ste 401
Sioux Falls, SD 57105
Phone (605) 322-8920

Interoperability endpoints

  • Direct secure messaging: dominique.boadwine@avera.sdhealthlink.net

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 and National Provider Directory roles.

  • Avera McKennan

    dba Avera McKennan Behavioral Health Clinic

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Sioux Falls, SD
    • NPI 1699009944
    Medicare reassignment Care Compare group NPD
  • Avera McKennan

    dba Avera Medical Group Urogynecology Sioux Falls

    • Obstetrics & Gynecology Physician
    • Sioux Falls, SD
    • NPI 1003188269
    NPD
  • Avera McKennan

    dba Avera Interventional Radiology

    • Diagnostic Radiology Physician
    • Sioux Falls, SD
    • NPI 1053680678
    NPD
  • Avera McKennan

    dba Avera McKennan Hospital and University Health Center

    • General Acute Care Hospital
    • Sioux Falls, SD
    • NPI 1568460772
    NPD (past)

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501632000000",
    "number": "1265956908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7710 MERCY RD STE 602",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7710 MERCY RD STE 602",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242371",
            "telephone_number": "402-280-4438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU BOADWINE",
        "first_name": "DOMINIQUE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-02",
        "last_updated": "2017-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NE",
            "license": "8080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.