Individual provider Active NPI

Erin Elaine Boatsman, M.D.

  • Pediatric Hematology & Oncology Physician
  • Los Angeles, CA
National Provider Identifier
1730202565
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
A94007 Issued in CA
Practice address
10833 Le Conte Ave
MDCC A2-410
Los Angeles, CA 90095-3075
Phone
(310) 825-6708
Fax
(310) 206-8089
NPI assigned
Apr 8, 2007
Last updated
Nov 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 23415 OK
Pediatric Hematology & Oncology Physician 2080P0207X A94007 CA Primary

Addresses

Primary practice location

10833 Le Conte Ave
MDCC A2-410
Los Angeles, CA 90095-3075

Mailing address

10833 Le Conte Ave
MDCC A2-410
Los Angeles, CA 90095-3075
Phone (310) 825-6708

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20091015000257 CA Practitioner - Pediatric MedicinePractitioner - Hematology/Oncology 4082750435 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23415OKMDPediatrics Physician
A94007CAMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jul 20, 2009 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 20, 2009 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
UC Regents Pediatrics PastSince Jul 5, 1994 Accepting new patients

Locations

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1175990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1730202565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE",
            "address_2": "MDCC A2-410",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900953075",
            "telephone_number": "310-825-6708",
            "fax_number": "310-206-8089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE",
            "address_2": "MDCC A2-410",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900953075",
            "telephone_number": "310-825-6708",
            "fax_number": "310-206-8089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOATSMAN",
        "first_name": "ERIN",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-08",
        "last_updated": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "23415",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "CA",
            "license": "A94007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.