NPIMap

Individual provider Active NPI

Richard W Boersma, MD

  • Family Medicine Physician
  • Zionsville, IN
National Provider Identifier
1558320051
Registry record updated Sep 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01028548 Issued in IN
Practice address
10801 N Michigan Rd Ste 110
Zionsville, IN 46077-8171
Phone
(317) 344-1269
NPI assigned
Mar 22, 2006
Last updated
Sep 15, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01028548 IN Primary

Addresses

Primary practice location

10801 N Michigan Rd Ste 110
Zionsville, IN 46077-8171

Mailing address

10330 N Meridian St
Indianapolis, IN 46290-1024

Other identifiers 3

IdentifierTypeStateIssuer
000000355597OtherILANTHEM
100216200MedicaidIN
IN01028548OtherININ LIC #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01028548INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Major Hospital Past Accepting new patients
Open Door Health Services, Inc. Past Accepting new patients
Meridian Health Services Corp Past Accepting new patients
Rush Memorial Hospital Past Accepting new patients

Organizations & group practices 4

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": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473897600000",
    "number": "1558320051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10330 N MERIDIAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462901024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10801 N MICHIGAN RD STE 110",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460778171",
            "telephone_number": "317-344-1269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOERSMA",
        "first_name": "RICHARD",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2016-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01028548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000355597",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100216200",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN LIC #",
            "identifier": "IN01028548",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Zionsville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2016; 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.