Individual provider Active NPI

Sue Boo, DO

  • Diagnostic Radiology Physician
  • Las Vegas, NV
National Provider Identifier
1306422761
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
14277086-1204 Issued in UT
Practice address
3100 N Tenaya Way
Graduate Medical Education
Las Vegas, NV 89128-0436
Phone
(301) 655-3838
NPI assigned
Mar 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 14277086-1204 UT Primary

Addresses

Primary practice location

3100 N Tenaya Way
Graduate Medical Education
Las Vegas, NV 89128-0436

Mailing address

3100 N Tenaya Way
Graduate Medical Education
Las Vegas, NV 89128-0436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20260608002477 UT Practitioner - Diagnostic Radiology 4688077126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2880 N Tenaya Way
FL 2
Las Vegas, NV 89128-0618

PO Box
Suite 299
Salt Lake City, UT 84110

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14277086-1204UTMDDiagnostic Radiology Physician

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": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1306422761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 N TENAYA WAY",
            "address_2": "GRADUATE MEDICAL EDUCATION",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 N TENAYA WAY",
            "address_2": "GRADUATE MEDICAL EDUCATION",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280436",
            "telephone_number": "301-655-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOO",
        "first_name": "SUE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-24",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "14277086-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.