NPIMap

Individual provider Active NPI

Henry Julius Boehm, MD

  • Diagnostic Radiology Physician
  • Waco, TX
National Provider Identifier
1790719888
Registry record updated May 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
J5143 Issued in TX
Practice address
3000 Herring Avenue
Waco, TX 76708
Phone
(254) 202-2000
Fax
(254) 753-6229
NPI assigned
Jul 11, 2006
Last updated
May 13, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X J5143 TX Primary

Addresses

Primary practice location

3000 Herring Avenue
Waco, TX 76708

Mailing address

PO Box 1888
Greenville, TX 75403
Phone (800) 945-2455

Other identifiers 2

IdentifierTypeStateIssuer
102082801MedicaidTX
102082803MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20041027001096 TX Practitioner - Diagnostic Radiology 3678535184 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Texas Medical Branch at Galveston, 1992
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

815 Pennsylvania Ave
Fort Worth, TX 76104-2224
Phone (817) 321-0470

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J5143TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hillcrest X-Ray Physicians Diagnostic Radiology CurrentSince Sep 1, 2004 Accepting new patients
Radiology Associates of North Texas PA Diagnostic Radiology CurrentSince Mar 1, 2025 Accepting new patients
Btdi JV LLP CurrentSince Oct 24, 2016 Accepting new patients
Radiology Associates of North Texas, PA Diagnostic Radiology CurrentSince Mar 1, 2025 Accepting new patients
Btdi JV, LLP CurrentSince Apr 14, 2025 Accepting new patients
Central Texas Advanced Medical Imaging LP Diagnostic Radiology Past Accepting new patients

Locations

101 S Avenue T
Clifton, TX 76634
Phone (254) 675-8322

17980 Dallas Pkwy
Ste 200
Dallas, TX 75287
Phone (972) 248-1303

815 Pennsylvania Ave
Ft Worth, TX 76104
Phone (817) 321-0300

816 W Cannon St
Ft Worth, TX 76104
Phone (817) 321-0312

2911 Herring Ave
Waco, TX 76708
Phone (254) 755-4410

3000 Herring Ave
Waco, TX 76708
Phone (254) 202-2000

312 Richland West Cir
Waco, TX 76712
Phone (254) 751-9490

Organizations & group practices 6

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 5

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1790719888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1888",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "75403",
            "telephone_number": "800-945-2455",
            "fax_number": "903-453-2541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 HERRING AVENUE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76708",
            "telephone_number": "254-202-2000",
            "fax_number": "254-753-6229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEHM",
        "first_name": "HENRY",
        "middle_name": "JULIUS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "J5143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102082801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102082803",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.