Douglas Boag, ARNP

Primary specialty

Critical Care Medicine Nurse PractitionerTaxonomy code 363LC0200X

License

11013299 Issued in FL

Practice address

2200 W Eau Gallie Blvd
Melbourne, FL 32935-3165

Phone

(321) 255-1500

NPI assigned

Jun 14, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Kidney Physicians LLCGroup PAC ID 4385925650, 167 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Palm Bay Hospital Hospital, Palm Bay, FL, CCN 100316

Merit-based Incentive Payment System (MIPS)

Final score

88.33 of 100Reported as group

Quality

70.52

Promoting interoperability

100

Improvement activities

40

Cost

73.91

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15644/brand/1/csg/1/fhir/r4
• Direct secure messaging: dboag71761@epicdirect.hf.org
• Direct secure messaging: douglas.boag.1@15644.direct.athenahealth.com

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.

• Florida Kidney Physicians, LLC

  • Nephrology Physician
  • Temple Terrace, FL
  • NPI 1760831564
  Medicare reassignment Care Compare group NPD
• Florida Kidney Physicians , LLC

  • Nephrology Physician
  • Melbourne, FL
  • NPI 1205506722
  NPD
• Medical Associates of Brevard LLC

  • Multi-Specialty Clinic/Center
  • Melbourne, FL
  • NPI 1861400103
  NPD (past)

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

• Holmes Regional Medical Center, Inc

  • General Acute Care Hospital
  • Palm Bay, FL
  • NPI 1386940823
  Care Compare affiliation

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1508434838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 W EAU GALLIE BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353165",
            "telephone_number": "321-255-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W EAU GALLIE BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353165",
            "telephone_number": "321-255-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOAG",
        "first_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-14",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "FL",
            "license": "11013299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dboag@mabmd.com",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2200 W Eau Gallie Blvd",
            "city": "Melbourne",
            "state": "FL",
            "country_code": "US",
            "postal_code": "329353165",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rosemarie Walsh Bloom, MASSAGE THERAPIST
• Blossom Medspa & Wellness Clinic, LLC
• Blue Wave Counseling
• Cora Marie Blum
• Ashley Blye
• Vonda Bobart, MD
• John Daniel Bocinsky, MD
• Amy K Bodart, DPM
• Bodhi Traditional Chinese Medicine Inc
• Shannon Bodilly, PT, DPT

• Critical Care Medicine Nurse Practitioner in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Critical Care Medicine Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.