NPIMap

Individual provider Active NPI

Bradley A Boone, M.D.

  • Vascular Surgery Physician
  • Georgetown, TX
National Provider Identifier
1730151457
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
P8338 Issued in TX
Practice address
3201 S Austin Ave
Georgetown, TX 78626-7545
Phone
(512) 459-8753
Fax
(512) 483-6807
NPI assigned
Feb 6, 2006
Last updated
Oct 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 44117 OK
Vascular Surgery Physician 2086S0129X P8338 TX Primary

Addresses

Primary practice location

3201 S Austin Ave
Georgetown, TX 78626-7545

Mailing address

2111 14TH St
Meridian, MS 39301-4041
Phone (601) 693-3834

Other identifiers 2

IdentifierTypeStateIssuer
201292450AMedicaidOK
333764R401MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK, SD3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140305001328 TX Practitioner - Vascular Surgery 9537061726 Reassigns benefits to 1 organization
I20240917002066 OK Practitioner - Vascular Surgery 9537061726 Reassigns benefits to 1 organization
I20241206001517 SD Practitioner - Vascular Surgery 9537061726 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Tulane University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cardiothoracic and Vascular Surgeons,PAGroup PAC ID 3870577729, 34 clinicians

Practice addresses (Care Compare)

1010 W 40TH St
Austin, TX 78756-4010
Phone (512) 459-8753

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-8109

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.74 of 100Reported as individual
Quality
68.25
Promoting interoperability
99
Improvement activities
40
Cost
88.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44117OKMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Oct 12, 2024 Accepting new patients
Monument Health Rapid City Hospital Inc CurrentSince Oct 3, 2024 Accepting new patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
Cardiothoracic and Vascular Surgeons,PA CurrentSince Dec 1, 2013 Accepting new patients
St. John Physicians, Inc. Current Accepting new patients
Monument Health Rapid City Hospital, Inc CurrentSince Oct 3, 2024 Accepting new patients
Meridian Crna LLC PastSince Oct 1, 2006 Accepting new patients
Anderson Physician Alliance, Inc. Past Accepting new patients

Locations

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

1010 W 40th St
Austin, TX 78756
Phone 5124598753102

1401 Medical Pkwy
Cedar Park, TX 78613
Phone (512) 528-7000

3201 S Austin Ave
Ste 255
Georgetown, TX 78626
Phone (512) 501-4287

Interoperability endpoints

  • Direct secure messaging: bradley.boone.1@856.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/856/brand/1/csg/1/fhir/r4

Organizations & group practices 8

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1730151457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 14TH ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014041",
            "telephone_number": "601-693-3834",
            "fax_number": "601-484-3225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 S AUSTIN AVE",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786267545",
            "telephone_number": "512-459-8753",
            "fax_number": "512-483-6807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOONE",
        "first_name": "BRADLEY",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "OK",
            "license": "44117",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TX",
            "license": "P8338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201292450A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "333764R401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.