Active NPI
John Boerner, M.D.
- Interventional Cardiology Physician
- Pueblo, CO
National Provider Identifier
1811934474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Cardiology Physician
- License
- 25866
- Practice address
- 3670 Parker Blvd Ste 101
Pueblo, CO 81008-2285 - Phone
- (719) 564-1544
- Fax
- (719) 924-1593
- NPI assigned
- Jun 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Cardiology Physician | 207RI0011X | 25866 | CO | Primary |
Addresses
Primary practice location
3670 Parker Blvd Ste 101
Pueblo, CO 81008-2285
Mailing address
3670 Parker Blvd Ste 101
Pueblo, CO 81008-2285
Phone (719) 564-1544
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01258664 | Medicaid | CO | |
| P00997262 | Other | CO | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25866 | CO | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Hospital Association of the San Luis Valley | Past | Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients | |
| Trinidad Area Health Association | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- General Acute Care Hospital
- Alamosa, CO
- NPI 1235181744
-
- Family Medicine Physician
- Trinidad, CO
- NPI 1467400309
-
- Critical Access Hospital
- Glasgow, MT
- NPI 1689685323
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377561600000",
"number": "1811934474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3670 PARKER BLVD STE 101",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082285",
"telephone_number": "719-564-1544",
"fax_number": "719-924-1593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3670 PARKER BLVD STE 101",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082285",
"telephone_number": "719-564-1544",
"fax_number": "719-924-1593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOERNER",
"first_name": "JOHN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-01",
"last_updated": "2013-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "CO",
"license": "25866",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01258664",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00997262",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.