Individual provider Active NPI

Walter Mark Boomer, MD

  • Pulmonary Disease Physician
  • Oklahoma City, OK
National Provider Identifier
1578598074
Registry record updated Jan 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
17300 Issued in OK
Practice address
13313 N Meridian Ave Ste D
Oklahoma City, OK 73120-8316
Phone
(405) 755-4290
Fax
(405) 755-7773
NPI assigned
Jul 12, 2006
Last updated
Jan 14, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 17300 OK Primary

Addresses

Primary practice location

13313 N Meridian Ave Ste D
Oklahoma City, OK 73120-8316

Mailing address

PO Box 776084
Chicago, IL 60677-6084
Phone (314) 364-4200

Other identifiers 1

IdentifierTypeStateIssuer
100090560AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100430000047 OK Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 8022045996 Reassigns benefits to 3 organizations
I20211102002157 TX Practitioner - Pulmonary Disease 8022045996 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
University of Oklahoma College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Creek Nation Hospital and ClinicsGroup PAC ID 5698786226, 364 clinicians
Warren Clinic IncGroup PAC ID 8820900293, 787 clinicians
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

10109 E 79TH St
Tulsa, OK 74133-4564
Phone (918) 756-4333

1313 E 20TH St
Okmulgee Indian Health Center
Okmulgee, OK 74447-6303
Phone (918) 591-5700

4318 W Okmulgee St
Muskogee, OK 74401-4648
Phone (918) 683-1831

5200 E I 240 Service Rd
Suite 330
Oklahoma City, OK 73135-2607
Phone (405) 755-4290

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Creek Nation Hospital & Clinics CurrentSince Feb 15, 2019 Accepting new patients
Mercy Clinic Oklahoma Communities CurrentSince Jan 2, 2026 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Apr 19, 2023 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Feb 15, 2019 Accepting new patients
Saint Francis Hospital, Inc. Past Accepting new patients

Locations

13313 N Meridian Ave
Ste D
Oklahoma City, OK 73120
Phone (405) 529-5759

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

5200 E I 240 Service Rd
Ste 330
Oklahoma City, OK 73135
Phone (405) 416-9703

1401 Morris Dr
Okmulgee, OK 74447
Phone (918) 456-0641

1401 Morris Dr
Ste 204
Okmulgee, OK 74447

900 E Airport Rd
Okmulgee, OK 74447
Phone 91875643334448

1125 E Cleveland Ave
Sapulpa, OK 74066
Phone (918) 224-9310

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

Dept 1038
Tulsa, OK 74182

Dept 1467
Tulsa, OK 74182

Interoperability endpoints

  • Direct secure messaging: wboomer17932@muscogeecreeknation.direct-ci.com
  • Direct secure messaging: wboomer60874@direct.saintfrancis.com

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768348800000",
    "number": "1578598074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "314-364-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13313 N MERIDIAN AVE STE D",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208316",
            "telephone_number": "405-755-4290",
            "fax_number": "405-755-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOMER",
        "first_name": "WALTER",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "OK",
            "license": "17300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100090560A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.