Active NPI
Kevin Boatright
- Allergy & Immunology Physician
- Farmington, MO
National Provider Identifier
1629185103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- R7D62
- Practice address
- 301 N Washington St
Suite 5
Farmington, MO 63640-1751 - Phone
- (573) 756-1744
- Fax
- (573) 756-2499
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R7D62 | MO | |
| Allergy & Immunology Physician | 207K00000X | R7D62 | MO | Primary |
Addresses
Primary practice location
301 N Washington St
Suite 5
Farmington, MO 63640-1751
Mailing address
670 Mason Ridge Center Dr
Suite 300
Saint Louis, MO 63141-8573
Phone (573) 756-1744
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201971702 | Medicaid | MO |
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
| License | State | Type | Specialty |
|---|---|---|---|
| R7D62 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Groups LC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352764800000",
"number": "1629185103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 MASON RIDGE CENTER DR",
"address_2": "SUITE 300",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418573",
"telephone_number": "573-756-1744",
"fax_number": "573-756-2499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 N WASHINGTON ST",
"address_2": "SUITE 5",
"city": "FARMINGTON",
"state": "MO",
"postal_code": "636401751",
"telephone_number": "573-756-1744",
"fax_number": "573-756-2499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOATRIGHT",
"first_name": "KEVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2012-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R7D62",
"primary": false
},
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "MO",
"license": "R7D62",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201971702",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Farmington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.