Douglas Lee Boertje, MD

Primary specialty

Pediatric Emergency Medicine (Emergency Medicine) PhysicianTaxonomy code 207PP0204X

License

2006-01516 Issued in NC

Practice address

501 S Sharon Amity Rd Ste 300
Charlotte, NC 28211-0035

Phone

(704) 377-2424

Fax

(704) 377-2687

NPI assigned

Jul 26, 2005

Last updated

Aug 23, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

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

Merit-based Incentive Payment System (MIPS)

Final score

84.97 of 100Reported as group

Quality

79.68

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mid-Atlantic Emergency Medical Associates, PLLC

  • Emergency Medicine Physician
  • Charlotte, NC
  • NPI 1073562757
  Medicare reassignment NPD
• Mema SC LLC

  • Emergency Medicine Physician
  • Charlotte, NC
  • NPI 1407675176
  NPD (past)
• Pediatric Emergency Specialists, PC

  • Pediatric Emergency Medicine (Emergency Medicine) Physician
  • Memphis, TN
  • NPI 1760482434
  NPD (past)

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1558361246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S SHARON AMITY RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282110035",
            "telephone_number": "704-377-2424",
            "fax_number": "704-377-2687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S SHARON AMITY RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282110035",
            "telephone_number": "704-377-2424",
            "fax_number": "704-377-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOERTJE",
        "first_name": "DOUGLAS",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "NC",
            "license": "2006-01516",
            "primary": true
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "TN",
            "license": "36257",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC MEDICAID",
            "identifier": "N01517",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59-05661",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Body Mechanix, Inc.
• Boe Healthcare Consulting
• Kathleen Kilroy Boeggeman, NP
• Otto Robert Boehm, MD
• William Boehringer, PA
• Richard Boesel, MD
• Lauren Elizabeth Bogenrief, PTA
• Chad Boger
• Grace Elizabeth Boger
• Katelyn Nicole Boger

• Pediatric Emergency Medicine (Emergency Medicine) Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatric Emergency Medicine (Emergency Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; 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.