Individual provider Active NPI

Maureen Boehm, MD

  • Internal Medicine Physician
  • Wheat Ridge, CO
National Provider Identifier
1306818729
Registry record updated Jul 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
39506 Issued in CO
Practice address
4350 Wadsworth Blvd
#201
Wheat Ridge, CO 80033-4641
Phone
(720) 898-9612
Fax
(720) 898-9614
NPI assigned
Feb 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 39506 CO Primary

Addresses

Primary practice location

4350 Wadsworth Blvd
#201
Wheat Ridge, CO 80033-4641

Mailing address

4350 Wadsworth Blvd
#201
Wheat Ridge, CO 80033-4641
Phone (720) 898-9612

Other identifiers 1

IdentifierTypeStateIssuer
98627732MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
39506COMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185840000000",
    "number": "1306818729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 WADSWORTH BLVD",
            "address_2": "#201",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334641",
            "telephone_number": "720-898-9612",
            "fax_number": "720-898-9614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 WADSWORTH BLVD",
            "address_2": "#201",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334641",
            "telephone_number": "720-898-9612",
            "fax_number": "720-898-9614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEHM",
        "first_name": "MAUREEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2007-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "39506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "98627732",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.