Individual provider Active NPI

Michael H. De Boer, M.D.

  • Emergency Medicine Physician
  • Knoxville, TN
National Provider Identifier
1780624809
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
19872 Issued in TN
Practice address
9352 Park West Blvd
Knoxville, TN 37923-4325
Phone
(865) 373-1000
NPI assigned
Jun 7, 2006
Last updated
Mar 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 46604 KY
Emergency Medicine Physician 207P00000X 19872 TN Primary

Addresses

Primary practice location

9352 Park West Blvd
Knoxville, TN 37923-4325

Mailing address

1431 Centerpoint Blvd
Suite 100
Knoxville, TN 37932-1984
Phone (865) 693-1000

Other practice location 1

310 N L Rogers Wells Blvd
Glasgow, KY 42141-1300
Phone (270) 659-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, KY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050210000237 TN Practitioner - Emergency Medicine 1052362738 Reassigns benefits to 3 organizations
I20140115000908 KY Practitioner - Family PracticePractitioner - Emergency Medicine 1052362738 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
University of Texas Medical Branch at Galveston, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Practice addresses (Care Compare)

1301 N Race St
Glasgow, KY 42141-3454
Phone (270) 651-4100

9352 Park W Blvd
Knoxville, TN 37923-4325
Phone (865) 373-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19872TNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC CurrentSince Aug 23, 2022 Accepting new patients
Afc Physicians of Tennessee, PC CurrentSince Jan 29, 2021 Accepting new patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Feb 1, 2014 Accepting new patients
Urgent Care Services Southeast PSC CurrentSince Oct 2, 2023 Accepting new patients
T J Samson Community Hospital CurrentSince Sep 10, 2020 Accepting new patients
Afc Physicians of Tennessee, PC CurrentSince Jan 29, 2021 Accepting new patients
Kentucky Post-Acute Medical Services 1 PSC CurrentSince Aug 23, 2022 Accepting new patients
Ky-I Medical Services, P.S.C. Past Accepting new patients

Locations

723 Burkesville Rd
Albany, KY 42602
Phone (606) 387-6421

1100 Brookhaven Rd
Franklin, KY 42134
Phone (270) 586-3253

1301 N Race St
Glasgow, KY 42141
Phone (270) 651-4444

310 N L Rogers Wells Blvd
Glasgow, KY 42141
Phone (270) 651-1111

299 Kings Daughters Dr
Hatton, KY 40601
Phone (502) 875-5240

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

1501 S Dixie St
Park, KY 42749
Phone (270) 745-1255

1015 Hunters Xing
Alcoa, TN 37701
Phone (856) 238-2006

111 Highway 70 E
Dickson, TN 37055
Phone (615) 441-2357

10820 Parkside Dr
Knoxville, TN 37934
Phone (865) 218-7011

1607 S Locust Ave
Lawrenceburg, TN 38464
Phone (731) 287-2244

6606 Charlotte Pike
Ste 104
Nashville, TN 37209
Phone (615) 630-6095

7565 Dannaher Dr
Powell, TN 37849
Phone (865) 545-8000

Organizations & group practices 9

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 2

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1780624809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 CENTERPOINT BLVD",
            "address_2": "SUITE 100",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379321984",
            "telephone_number": "865-693-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9352 PARK WEST BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234325",
            "telephone_number": "865-373-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 N L Rogers Wells Blvd",
            "address_purpose": "LOCATION",
            "city": "Glasgow",
            "state": "KY",
            "postal_code": "421411300",
            "country_code": "US",
            "telephone_number": "270-659-5555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE BOER",
        "first_name": "MICHAEL",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "46604",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "19872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.