Individual provider Active NPI

Praba Boominathan, MD

  • Pain Medicine (Anesthesiology) Physician
  • Philadelphia, PA
National Provider Identifier
1629456074
Registry record updated Jun 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
MD468544 Issued in PA
Practice address
3400 Spruce Street
Philadelphia, PA 19104-4206
Phone
(215) 349-8310
Fax
(215) 893-7270
NPI assigned
May 18, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X MD468544 PA Primary

Addresses

Primary practice location

3400 Spruce Street
Philadelphia, PA 19104-4206

Mailing address

3400 Spruce Street
Philadelphia, PA 19104-4206
Phone (215) 349-8310

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20200527000088 PA Practitioner - Anesthesiology 7719290600 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Rutgers School of Dental Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 349-8310

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD468544PAMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince Jul 1, 2020 Accepting new patients
University of Penn-Medical Group Anesthesiology CurrentSince Jul 1, 2020 Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

1001 Chesterbrook Blvd
Fl 3W
Berwyn, PA 19312

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

3737 Market St
Fl 5
Philadelphia, PA 19104
Phone (215) 847-2064

3737 Market St
Fl 8
Philadelphia, PA 19104
Phone (215) 662-4333

1840 South St
Bldg 2ND
Philadelphia, PA 19146
Phone (215) 893-7244

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

200 Willowbrook Ln
Ste 210
West Chester, PA 19382
Phone (610) 696-8900

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1629456074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-349-8310",
            "fax_number": "215-893-7270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-349-8310",
            "fax_number": "215-893-7270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOMINATHAN",
        "first_name": "PRABA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-18",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "PA",
            "license": "MD468544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.