Individual provider Active NPI

Mark Earl Bomia, DO

  • Diagnostic Radiology Physician
  • Okatie, SC
National Provider Identifier
1790855674
Registry record updated Mar 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
36489 Issued in SC
Practice address
719 Okatie Hwy # 170
Okatie, SC 29909-3963
Phone
(843) 987-7400
NPI assigned
Nov 8, 2006
Last updated
Mar 31, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 02003096A IN
Diagnostic Radiology Physician 2085R0202X 36489 SC Primary

Addresses

Primary practice location

719 Okatie Hwy # 170
Okatie, SC 29909-3963

Mailing address

PO Box 357
Ridgeland, SC 29936-2605
Phone (843) 987-7400

Other practice location 1

1 Pinckney Blvd
Beaufort, SC 29902-6122
Phone (843) 228-5440

Other practice location 2

PO Box 357
Ridgeland, SC 29936-2605
Phone (843) 987-7400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20250429001576 SC Practitioner - Diagnostic Radiology 3779009154 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02003096AINMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beaufort Jasper Hampton Comprehensive Health Services, Inc CurrentSince Mar 31, 2025 Accepting new patients
Beaufort Jasper Hampton Comprehensive Health Services, Inc. CurrentSince Mar 31, 2025 Accepting new patients

Locations

719 Okatie Hwy
Okatie, SC 29909

721 Okatie Hwy
Okatie, SC 29909

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EICIBD

Organizations & group practices 2

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": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743379200000",
    "number": "1790855674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 357",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "299362605",
            "telephone_number": "843-987-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 OKATIE HWY # 170",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299093963",
            "telephone_number": "843-987-7400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Pinckney Blvd",
            "address_purpose": "LOCATION",
            "city": "Beaufort",
            "state": "SC",
            "postal_code": "299026122",
            "country_code": "US",
            "telephone_number": "843-228-5440",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "PO Box 357",
            "address_purpose": "LOCATION",
            "city": "Ridgeland",
            "state": "SC",
            "postal_code": "299362605",
            "country_code": "US",
            "telephone_number": "843-987-7400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOMIA",
        "first_name": "MARK",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "02003096A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "36489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Okatie, SC

Sources for this page

Verify at the official NPI Registry.