Mark Boulware, M.D.

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

DR.0054836 Issued in CO

Practice address

1400 E Boulder St
Suite 700
Colorado Springs, CO 80909-5533

Phone

(719) 635-7172

Fax

(719) 444-3717

NPI assigned

Apr 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Interventional CardiologyAlso: Nuclear Medicine

Education

University of Missouri, Kansas City, School of Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022
• Uchealth Grandview Hospital Hospital, Colorado Springs, CO, CCN 060130
• Uchealth Pikes Peak Regional Hospital Hospital, Woodland Park, CO, CCN 061326
• Prowers Medical Center Hospital, Lamar, CO, CCN 061323
• Mt San Rafael Hospital Hospital, Trinidad, CO, CCN 061321

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868
  Medicare reassignment Care Compare group NPD
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260
  NPD
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1144397134
  NPD (past)
• Taos Health Systems, Inc., Holy Cross Hospital

  • Critical Access Hospital
  • Taos, NM
  • NPI 1902338049
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prowers County Hospital District

  • Critical Access Hospital
  • Lamar, CO
  • NPI 1821052929
  Care Compare affiliation
• Trinidad Area Health Association

  • Critical Access Hospital
  • Trinidad, CO
  • NPI 1184616740
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1073172201
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1124518113
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1144397134
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1154030732
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Fountain, CO
  • NPI 1295225274
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1316506231
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1407532559
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1518526441
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1538958400
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1578053567
  Care Compare affiliation

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423526400000",
    "number": "1437375318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE",
            "address_2": "SUITE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805388702",
            "telephone_number": "970-624-4443",
            "fax_number": "970-490-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E BOULDER ST",
            "address_2": "SUITE 700",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095533",
            "telephone_number": "719-635-7172",
            "fax_number": "719-444-3717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULWARE",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2015-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2006-01834",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CO",
            "license": "DR.0054836",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CO",
            "license": "DR.0054836",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Boudreau, AGPCNP
• Katherine Boudreaux, PHARM. D.
• Susan L Boudreaux, LMFT
• Boulder and the Pine Wellness
• Julia Boulton, LPC
• Boundless Compassion LLC
• Alison Elizabeth Bounds, RBT
• Roxanne Bourassa
• Dawn Michelle Boutte, PT
• Pamela Renee Bouvier, LMT

• Interventional Cardiology Physician in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Interventional Cardiology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; 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.