Elisa Boma Garcia

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

20007 Issued in KY

Practice address

1237 Woodland Dr
Elizabethtown, KY 42701-2709

Phone

(270) 769-6875

Fax

(270) 737-9696

NPI assigned

May 24, 2006

Sex

Female

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 5

Medicare fee-for-service enrollment

Enrolled in KY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214784000000",
    "number": "1700831781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1237 WOODLAND DR",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012709",
            "telephone_number": "270-769-6875",
            "fax_number": "270-737-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1237 WOODLAND DR",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012709",
            "telephone_number": "270-769-6875",
            "fax_number": "270-737-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA",
        "first_name": "ELISA",
        "middle_name": "BOMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2008-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "KY",
            "license": "20007",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "KY",
            "license": "20007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000050918",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "1050021",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "130012244",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64200014",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2432753000",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• April Ra'Chel Gaddie
• Laine Gaddie
• Monica Gahagan, C.O.T.A.
• Dontavius Gaines, APSS
• Lisa Christine Gaines, DNP, APRN
• Lovegildo S Garcia Jr., M.D.
• Reba Kay Garcia
• Sarah Lynn Gardner, MSN, APRN, FNP-C
• Vanessa Garr, LPCC
• Georgina Elizabeth Garrett

• Neurology Physician in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Neurology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.