Boomer Medical Clinic

Primary specialty

Spinal Cord Injury Medicine PhysicianTaxonomy code 2081P0004X

License

G72879 Issued in CA

Legal business name

BOOMER MEDICAL CLINIC

Practice address

3525 Watt Ave
Sacramento, CA 95821

Phone

(916) 480-0707

NPI assigned

Apr 1, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly Le, M.D.

Title

Medical Director

Phone

(916) 480-0707

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kim Le, MD

  • Spinal Cord Injury Medicine Physician
  • Sacramento, CA
  • NPI 1902046287
  NPD (past)

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

{
    "created_epoch": "1301616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1538458351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1939",
            "city": "CARMICHAEL",
            "state": "CA",
            "postal_code": "956091939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3525 WATT AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95821",
            "telephone_number": "916-480-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOMER MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-01",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "916-480-0707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A46083",
            "primary": false
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "CA",
            "license": "G72879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph L. Booker
• Gazzell L. Bookman
• Christina Bookout, RN
• Mary Boom, CMA
• Toni Boom
• James Boone, MD
• Jasmine Boone
• Julie Ann Marie Boone
• Larry D Boone, RTC
• Lynne Marie Boone

• Spinal Cord Injury Medicine Physician in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Spinal Cord Injury Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.