Brian T Boden, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7060654-1206 Issued in UT

Practice address

1975 N State St
Orem, UT 84057-2028

Phone

(801) 714-5000

NPI assigned

Nov 4, 2005

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

90.93 of 100Reported as group

Quality

70.1

Promoting interoperability

100

Improvement activities

40

Cost

83.01

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bboden@direct.scf.cc

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.

• Alaska Native Tribal Health Consortium

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1437189339

  TX

  Medicare reassignment NPD
• Southcentral Foundation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • McGrath, AK
  • NPI 1780614263

  TX

  Medicare reassignment
• Southcentral Foundation

  • Chiropractor
  • Wasilla, AK
  • NPI 1750889234
  NPD
• Sterling Emergency Services of Oklahoma, Inc.

  • Nurse Practitioner
  • Tulsa, OK
  • NPI 1366480295

  Physician Assistant

  NPD (past)
• TRT Medical PLLC

  • Internal Medicine Physician
  • Cleveland, OK
  • NPI 1215120613
  NPD (past)

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311552000000",
    "number": "1316938673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-714-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 N STATE ST",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840572028",
            "telephone_number": "801-714-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODEN",
        "first_name": "BRIAN",
        "middle_name": "T",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2011-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1391",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "7060654-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200052790A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Macie Mariah Bloomer
• Melinda Bluford
• Melissa J. Blumell, CMHC
• Ruby Bluth
• Laura Lynn Boberg, SUDC
• Jadyn Bohn
• Daniel Bolanos
• Samantha Bolton, DNP
• Bryan Felipe Bonilla-Alberto, CSW
• Carlos Eduardo Bonilla, APRN

• All providers in Orem, UT
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.