Sydney Lane Boule, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

P4426 Issued in TX

Practice address

919 Hidden RDG
Floor 6
Irving, TX 75038-3813

Phone

(469) 282-2713

Fax

(469) 282-2609

NPI assigned

Apr 28, 2011

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 1

Other names 1

• Sydney Lane Vonk Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4
• Direct secure messaging: sboule65399@memorialhermann.direct-ci.com
• Direct secure messaging: sydney.boule.1@996.direct.athenahealth.com

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.

• C H Wilkinson Physician Network

  • Family Medicine Physician
  • Irving, TX
  • NPI 1457382947
  NPD
• C H Wilkinson Physician Network

  • Orthopaedic Surgery Physician
  • Corpus Christi, TX
  • NPI 1750826095
  NPD

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

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1730470451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 HIDDEN RDG",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750383813",
            "telephone_number": "469-282-2713",
            "fax_number": "469-282-2609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 HIDDEN RDG",
            "address_2": "FLOOR 6",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750383813",
            "telephone_number": "469-282-2713",
            "fax_number": "469-282-2609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULE",
        "first_name": "SYDNEY",
        "middle_name": "LANE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-28",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P4426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "341874101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SYDNEY",
            "last_name": "VONK",
            "middle_name": "LANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• McKinley Bostad
• Robert Boston
• Ashley Rose Boterf
• Zachary Alan Boucher
• Kelly Bouie
• Paul B Bourland, NP-C
• Thernessia Lashon Bowe, PMHNP-BC
• Kevin Rudy Bower, MD
• Natasha Bowler, FNP
• Raegan Grace Bowling

• Family Medicine Physician in Irving, TX
• Providers in Irving, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.