NPIMap

Organization Active NPI

Debra R. Boender, DPM, PHD, LLC

  • Podiatrist
  • Crisfield, MD
National Provider Identifier
1831192095
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
01409 Issued in MD
Legal business name
DEBRA R. BOENDER, DPM, PHD, LLC
Practice address
26553 Mariners Rd
Crisfield, MD 21817-2109
Phone
(410) 465-4410
NPI assigned
May 23, 2005
Last updated
Jun 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Authorized official

Name
Dr. Debra R Boender, D.P.M.NPI 1851394027
Title
Sole Practitioner/Proprietor
Phone
(410) 465-4410

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 01409 MD Primary

Addresses

Primary practice location

26553 Mariners Rd
Crisfield, MD 21817-2109

Mailing address

26553 Mariners Rd
Crisfield, MD 21817-2109
Phone (410) 465-4410

Other identifiers 8

IdentifierTypeStateIssuer
002216100MedicaidMD
DC9138OtherMDRAILROAD MEDICARE
606937400OtherMDFED WORKERS COMP/DOL
002485895002OtherMDUNITED HEALTHCARE
K4150001OtherMDCAREFIRST FED AND DC AREA
01409OtherMDMARYLAND STATE LICENSE
2137828OtherMDONE NET
689BP0/64490301OtherMDCAREFIRST BC/BS NASCO

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1831192095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26553 MARINERS RD",
            "city": "CRISFIELD",
            "state": "MD",
            "postal_code": "218172109",
            "telephone_number": "410-465-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26553 MARINERS RD",
            "city": "CRISFIELD",
            "state": "MD",
            "postal_code": "218172109",
            "telephone_number": "410-465-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEBRA R. BOENDER, DPM, PHD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "BOENDER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SOLE PRACTITIONER/PROPRIETOR",
        "authorized_official_telephone_number": "410-465-4410",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MD",
            "license": "01409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002216100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC9138",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED WORKERS COMP/DOL",
            "identifier": "606937400",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "002485895002",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST FED AND DC AREA",
            "identifier": "K4150001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND STATE LICENSE",
            "identifier": "01409",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONE NET",
            "identifier": "2137828",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS NASCO",
            "identifier": "689BP0/64490301",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crisfield, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.