NPIMap

Individual provider Active NPI

John L Boedeker, DO

  • Family Medicine Physician
  • Mason City, IA
National Provider Identifier
1780795393
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
03763 Issued in IA
Practice address
1010 4TH St SW
Mason City, IA 50401
Phone
(641) 428-6020
Fax
(641) 428-7803
NPI assigned
Aug 31, 2006
Last updated
Jul 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 03763 IA Primary

Addresses

Primary practice location

1010 4TH St SW
Mason City, IA 50401

Mailing address

1010 4TH St SW
Mason City, IA 50401-2857
Phone (641) 428-6020

Other identifiers 1

IdentifierTypeStateIssuer
0452011MedicaidIA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jboedeker3940442@direct.trinity-health.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070906000014 IA Practitioner - Family Practice 9335232420 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Iowa Mercy ClinicsGroup PAC ID 7810809076, 304 clinicians

Practice addresses (Care Compare)

1000 4TH St SW
Mason City, IA 50401-2800

1010 4TH St SW
Mason City, IA 50401-2856

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.55 of 100Reported as group
Quality
73.89
Promoting interoperability
93
Improvement activities
40
Cost
70.44

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03763IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Iowa Mercy Clinics Current Accepting new patients
North Iowa Mercy Clinics Family Medicine CurrentSince May 1, 2012 Accepting new patients
North Iowa Mercy Clinics CurrentSince May 1, 2012 Accepting new patients
Floyd County Memorial Hospital Commission Family Medicine Past Accepting new patients
North Iowa Mercy Clinics Past Accepting new patients

Locations

532 1st St NW
Britt, IA 50423
Phone (641) 843-4403

1000 4th St SW
Mason City, IA 50401
Phone (641) 424-6704

1010 4th St SW
Ste 120
Mason City, IA 50401
Phone (515) 422-6020

621 S Illinois Ave
Ste 103
Mason City, IA 50401

Interoperability endpoints

  • Direct secure messaging: jboedeker3940442@direct.trinity-health.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Good Shepherd Health CenterMason City, IA, CCN 165072 Skilled nursing facility Corporate Director Jan 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 6

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1780795393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 4TH ST SW",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504012857",
            "telephone_number": "641-428-6020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 4TH ST SW",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "50401",
            "telephone_number": "641-428-6020",
            "fax_number": "641-428-7803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEDEKER",
        "first_name": "JOHN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "03763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0452011",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jboedeker3940442@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "MercyOne North Iowa Direct Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1010 4th St SW",
            "city": "Mason City",
            "state": "IA",
            "country_code": "US",
            "postal_code": "50401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mason City, IA

Sources for this page

Verify at the official NPI Registry.