Individual provider Active NPI

Adam Michael Van Den Boom, M.D.

  • Hospitalist Physician
  • San Antonio, TX
National Provider Identifier
1295935716
Registry record updated Dec 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
R5670 Issued in TX
Practice address
5430 Fredericksburg Rd Ste 508
San Antonio, TX 78229
Phone
(210) 541-8281
Fax
(210) 541-9123
NPI assigned
Jul 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2018

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0101243986 VA
Pediatrics Physician 208000000X R5670 TX
General Practice Physician 208D00000X 0101243986 VA
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X R5670 TX Primary

Addresses

Primary practice location

5430 Fredericksburg Rd Ste 508
San Antonio, TX 78229

Mailing address

5430 Fredericksburg Rd Ste 508
San Antonio, TX 78229-3561
Phone (210) 541-8281

Other practice location 1

554 Keily Street
Jacksonville, FL 32212
Phone (757) 953-7550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20180730000802 TX Practitioner - Pediatric Medicine 9830447424 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101243986VAMDGeneral Practice Physician
R5670TXMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Magella Medical Associates Billing, Inc. Multi-Specialty CurrentSince Jun 15, 2018 Accepting new patients

Locations

3901 W 15th St
Plano, TX 75075
Phone (972) 519-1115

3001 George Bush Hwy
Ste 250
Richardson, TX 75082
Phone (888) 822-2855

5430 Fredericksburg Rd
Ste 508
San Antonio, TX 78229
Phone (210) 541-8281

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544745600000",
    "number": "1295935716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 FREDERICKSBURG RD STE 508",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293561",
            "telephone_number": "210-541-8281",
            "fax_number": "210-541-9123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5430 FREDERICKSBURG RD STE 508",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78229",
            "telephone_number": "210-541-8281",
            "fax_number": "210-541-9123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "554 Keily Street",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32212",
            "country_code": "US",
            "telephone_number": "757-953-7550",
            "fax_number": "757-953-7560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN DEN BOOM",
        "first_name": "ADAM",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-23",
        "last_updated": "2018-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101243986",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "R5670",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101243986",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "R5670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.