Individual provider Active NPI

Eric Boorman, M.D.

  • Anesthesiology Physician
  • Tacoma, WA
National Provider Identifier
1508833179
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
42381 Issued in WA
Practice address
3633 Pacific Ave
Suite 204
Tacoma, WA 98418-7900
Phone
(253) 274-1668
NPI assigned
Mar 2, 2006
Last updated
Mar 15, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 42381 WA Primary

Addresses

Primary practice location

3633 Pacific Ave
Suite 204
Tacoma, WA 98418-7900

Mailing address

3633 Pacific Ave
Suite 204
Tacoma, WA 98418-7900
Phone (253) 274-1668

Other identifiers 1

IdentifierTypeStateIssuer
8405359MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
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

Enrollment IDStateProvider typePAC IDDetails
I20180626000349 HI Practitioner - AnesthesiologyPractitioner - Pediatric Medicine 7416915483 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pediatric Medicine
Education
University of South Florida College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kapiolani Medical SpecialistsGroup PAC ID 0648183988, 103 clinicians

Practice addresses (Care Compare)

1319 Punahou St
Honolulu, HI 96826-1001
Phone (808) 983-6000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42381WAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kapiolani Medical Specialists CurrentSince Dec 30, 2019 Accepting new patients
Hawaii Anesthesia Group Inc Anesthesiology CurrentSince Jun 1, 2018 Accepting new patients

Locations

1319 Punahou St
Honolulu, HI 96826
Phone (808) 485-4300

1575 S Beretania St
Ste 201-202
Honolulu, HI 96826
Phone (808) 352-2081

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1508833179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3633 PACIFIC AVE",
            "address_2": "SUITE 204",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984187900",
            "telephone_number": "253-274-1668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3633 PACIFIC AVE",
            "address_2": "SUITE 204",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984187900",
            "telephone_number": "253-274-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOORMAN",
        "first_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "42381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8405359",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.