Individual provider Active NPI

Julie Boom, MD

  • Pediatrics Physician
  • Houston, TX
National Provider Identifier
1366522799
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
J5546 Issued in TX
Practice address
6701 Fannin St
Houston, TX 77030-2316
Phone
(832) 822-3436
Fax
(832) 825-3455
NPI assigned
Oct 17, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X J5546 TX Primary

Addresses

Primary practice location

6701 Fannin St
Houston, TX 77030-2316

Mailing address

6701 Fannin St
Houston, TX 77030-2316
Phone (832) 822-3436

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
I20150506001658 TX Practitioner - Pediatric Medicine 9537488903 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J5546TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baylor College of Medicine CurrentSince Mar 22, 2015 Accepting new patients
Baylor College of Medicine CurrentSince Mar 22, 2015 Accepting new patients
Texas Children's Physician Group Pediatrics Past Accepting new patients

Locations

1504 Taub Loop
Houston, TX 77030
Phone (713) 873-2860

2 Greenway Plz
Ste 900
Houston, TX 77046
Phone (713) 798-1835

6701 Fannin St
Houston, TX 77030
Phone (832) 822-1764

6701 Fannin St
Ste 1420
Houston, TX 77030
Phone (832) 822-4240

Interoperability endpoints

  • Direct secure messaging: jboom5850@prddirect.texaschildrens.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366522799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302316",
            "telephone_number": "832-822-3436",
            "fax_number": "832-825-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302316",
            "telephone_number": "832-822-3436",
            "fax_number": "832-825-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOM",
        "first_name": "JULIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "J5546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.