Jill E Boulden, MD
Individual provider Active NPI Family Medicine Physician · Tomah, WI
NPI 1508077520 · NPPES record last updated May 17, 2019
Key facts
- NPI
- 1508077520
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 50635 (WI)
- Practice address
- 325 Butts Ave
Tomah, WI 54660-1412 - Phone
- (608) 372-5951
- Fax
- (608) 372-3436
- NPI assigned
- May 24, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
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 |
|---|---|---|---|---|
| I20071001000742 | WI | Practitioner - Family Practice | 0749375095 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50635 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Black River Health Inc | Current |
Accepting new patients | |
| Gundersen Clinic LTD | Current |
Accepting new patients | |
| Tomah Memorial Hospital Inc | Current | Accepting new patients | |
| Gundersen Lutheran Express Care, Inc | Current |
Accepting new patients | |
| Black River Memorial Hospital Inc | Current |
Accepting new patients | |
| Black River Health Inc | Current | Accepting new patients | |
| Tomah Memorial Hospital Inc | Current |
Accepting new patients | |
| Tomah Memorial Hospital Inc | Current |
Accepting new patients | |
| Mayo Clinic Health System-Southwest Wisconsin Region, Inc. | Past | Accepting new patients |
Locations
711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-1302
402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331
705 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 357-2000
310 W Main St
Sparta, WI 54656
Phone (608) 269-1700
325 Butts Ave
Tomah, WI 54660
Phone (608) 372-5951
501 Gopher Dr
#2
Tomah, WI 54660
501 Gopher Dr
Tomah, WI 54660
Phone (608) 371-2181
321 Butts Ave
Tomah, WI 54660
Phone (608) 372-2181
101 Unity Dr
Warrens, WI 54666
Phone (608) 372-2181
Interoperability endpoints
- jboulden821463@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 50635 | WI | Yes |
Addresses
Primary practice location
325 Butts Ave
Tomah, WI 54660-1412
Mailing address
PO Box 1510
Eau Claire, WI 54702-1510
Phone (608) 785-0940
Other providers in Tomah, WI
- Sarah Black
- Carolyn Rae Blackdeer
- Elliot Blackdeer
- Blado Dental Clinic LTD.
- Esta Amanda Blevins
- Thomas E Boulden
- Zachary John Boulden
- Karina Boyea
- Moriah Boyum
- Michael John Brandt
All providers in Tomah, 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 May 17, 2019. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.