Jill E Boulden, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

50635 Issued in WI

Practice address

325 Butts Ave
Tomah, WI 54660-1412

Phone

(608) 372-5951

Fax

(608) 372-3436

NPI assigned

May 24, 2007

Last updated

May 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jboulden821463@direct.emplifyhealth.org

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.

• Black River Health Inc

  • Critical Access Hospital
  • Black River Falls, WI
  • NPI 1811940331
  Medicare reassignment NPD
• Gundersen Clinic LTD

  • Clinic/Center
  • La Crosse, WI
  • NPI 1851343115
  Medicare reassignment NPD
• Tomah Memorial Hospital Inc

  dba Tomah Health

  • Critical Access Hospital
  • Tomah, WI
  • NPI 1184765240
  Medicare reassignment NPD
• Tomah Memorial Hospital Inc

  dba Tomah Health

  • Critical Access Hospital
  • Tomah, WI
  • NPI 1992970453
  Medicare reassignment NPD
• Black River Health Inc

  dba Black River Healthcare Clinic

  • Rural Health Clinic/Center
  • Black River Falls, WI
  • NPI 1255183182
  NPD
• Black River Memorial Hospital Inc

  • Home Health Agency
  • Black River Falls, WI
  • NPI 1215085253
  NPD
• Gundersen Lutheran Express Care, Inc

  • Clinic/Center
  • La Crosse, WI
  • NPI 1043446974
  NPD
• Tomah Memorial Hospital Inc

  dba Tomah Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Tomah, WI
  • NPI 1205978046
  NPD
• Mayo Clinic Health System-Southwest Wisconsin Region, Inc.

  dba Mayo Clinic Health System - La Crosse

  • Multi-Specialty Clinic/Center
  • La Crosse, WI
  • NPI 1629056049
  NPD (past)

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558051200000",
    "number": "1508077520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547021510",
            "telephone_number": "608-785-0940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 BUTTS AVE",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546601412",
            "telephone_number": "608-372-5951",
            "fax_number": "608-372-3436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDEN",
        "first_name": "JILL",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-24",
        "last_updated": "2019-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "50635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Black, RN
• Carolyn Rae Blackdeer, LCSW
• Elliot Blackdeer
• Blado Dental Clinic LTD.
• Esta Amanda Blevins, MSW, LCSW
• Thomas E Boulden, OD
• Zachary John Boulden
• Karina Boyea
• Moriah Boyum
• Michael John Brandt, PH.D.

• Family Medicine Physician in Tomah, WI
• Providers in Tomah, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.