NPIMap

Individual provider Active NPI

Benjamin Jelinek Boardman, MD

  • Family Medicine Physician
  • Onalaska, WI
National Provider Identifier
1487749396
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39498 Issued in WI
Practice address
3111 Gundersen Dr
Onalaska, WI 54650-8447
Phone
(608) 782-7300
NPI assigned
Oct 4, 2006
Last updated
Oct 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39498 WI Primary

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 3

IdentifierTypeStateIssuer
32399800MedicaidWI
51470OtherWISECURITY HEALTH PLAN
80192405OtherWIPALMETTO GBA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111018000742 WI Practitioner - Family Practice 6103098033 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
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

Practice addresses (Care Compare)

3111 Gundersen Dr
Onalaska, WI 54650-8447
Phone (608) 782-7300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.64 of 100Reported as group
Quality
97.3
Promoting interoperability
100
Improvement activities
40
Cost
74.83

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39498WIMDFamily Medicine Physician
36232MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Black River Memorial Hospital Inc CurrentSince Jan 19, 2013 Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Oct 28, 2024 Accepting new patients
Black River Health Inc CurrentSince Jan 19, 2013 Accepting new patients
Upland Hills Health, Inc CurrentSince Apr 3, 2017 Accepting new patients
Black River Health Inc Current Accepting new patients
Upland Hills Health Inc Current Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Oct 28, 2024 Accepting new patients
Gundersen Lutheran Medical Center, Inc. Family Medicine Past Accepting new patients
Gundersen Lutheran Medical Center Inc Past Accepting new patients

Locations

711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-3604

800 Compassion Way
Dodgeville, WI 53533
Phone (608) 930-7200

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

3111 Gundersen Dr
Onalaska, WI 54650
Phone (608) 775-8100

Interoperability endpoints

  • Direct secure messaging: bboardman913109@direct.emplifyhealth.org

Organizations & group practices 9

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1487749396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 GUNDERSEN DR",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546508447",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N6520 Guy Road",
            "address_purpose": "LOCATION",
            "city": "Black River Falls",
            "state": "WI",
            "postal_code": "54615",
            "country_code": "US",
            "telephone_number": "715-284-9851",
            "fax_number": "715-284-5150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOARDMAN",
        "first_name": "BENJAMIN",
        "middle_name": "JELINEK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "39498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32399800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURITY HEALTH PLAN",
            "identifier": "51470",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "80192405",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Onalaska, WI

Sources for this page

Verify at the official NPI Registry.