Marc Alan Booth, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

01061093A Issued in IN

Practice address

1225 E Coolspring Ave Ste 1-B
Michigan City, IN 46360-6312

Phone

(219) 879-6531

NPI assigned

Nov 18, 2005

Last updated

Feb 13, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: mbooth985551@direct.unc.nchie.net

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.

• CGH Medical Center

  dba CGH Medical Center-Vision Center

  • Durable Medical Equipment & Medical Supplies
  • Sterling, IL
  • NPI 1811014525
  NPD (past)
• Eye Care Specialists, LLC

  • Ophthalmology Physician
  • Cape Girardeau, MO
  • NPI 1316071780
  NPD (past)

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1275515710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 E COOLSPRING AVE STE 1-B",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463606312",
            "telephone_number": "219-879-6531"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2226 Nelson Hwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Chapel Hill",
            "state": "NC",
            "postal_code": "275179638",
            "country_code": "US",
            "telephone_number": "984-974-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "MARC",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NC",
            "license": "2023-00058",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "01061093A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200527370",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbooth985551@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2226 Nelson Hwy Ste 200",
            "city": "Chapel Hill",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275179638",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• BKRD, Inc
• Billie-Ann Black, DNP
• Elizabeth Black
• Karmyn Boller, LSW
• Chad A Booth, LSW
• Thomas J Bormann, DDS
• Jacob Bowersock
• Holly Bradford, NP
• Mary Ann Brandon, SLP
• Constance Brennen, LMHC

• Ophthalmology Physician in Michigan City, IN
• Providers in Michigan City, IN by specialty
• Ophthalmology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; 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.