Benjamin Jelinek Boardman, MD
Individual provider Active NPI Family Medicine Physician · Onalaska, WI
NPI 1487749396 · NPPES record last updated Oct 11, 2024
Key facts
- NPI
- 1487749396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 39498 (WI)
- Practice address
- 3111 Gundersen Dr
Onalaska, WI 54650-8447 - Phone
- (608) 782-7300
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 21
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Icahn School of Medicine at Mount Sinai, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gundersen Lutheran Medical Center Inc
Practice addresses (Care Compare)
3111 Gundersen Dr
Onalaska, WI 54650-8447
Phone (608) 782-7300
Hospital & facility affiliations
- Gundersen Lutheran Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.64 of 100
- Quality
- 97.3
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.83
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111018000742 | WI | Practitioner - Family Practice | 6103098033 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39498 | WI | MD | Family Medicine Physician |
| 36232 | MN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Black River Memorial Hospital Inc | Current |
Accepting new patients | |
| Black River Health Inc | Current |
Accepting new patients | |
| Upland Hills Health Inc | Current | Accepting new patients | |
| Upland Hills Health, Inc | Current |
Accepting new patients | |
| Black River Health Inc | Current | Accepting new patients | |
| Gundersen Lutheran Medical Center, Inc | Current |
Accepting new patients | |
| Gundersen Lutheran Medical Center Inc | Current |
Accepting new patients | |
| Gundersen Lutheran Medical Center Inc | Past | Accepting new patients |
Locations
711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-1302
800 Compassion Way
Dodgeville, WI 53533
Phone (608) 930-7200
1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287
1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102
3111 Gundersen Dr
Onalaska, WI 54650
Phone (608) 775-8100
Interoperability endpoints
- bboardman913109@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 39498 | WI | Yes |
Addresses
Primary practice location
3111 Gundersen Dr
Onalaska, WI 54650-8447
Mailing address
1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300
Other practice location 1
N6520 Guy Road
Black River Falls, WI 54615
Phone (715) 284-9851
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32399800 | Medicaid | WI | |
| 80192405 | Other | WI | PALMETTO GBA |
| 51470 | Other | WI | SECURITY HEALTH PLAN |
Other providers in Onalaska, WI
- Bethany-St Joseph Corporation
- Dustin Billups
- Bridget Natasha Bird I
- Daniel Craig Bird
- Katelyn Bjorge
- Susan L Bock
- James Timothy Bodoh
- William Boisvert
- Kathleen L Bondow
- Jerome Paul Boortz
All providers in Onalaska, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.