Active NPI
Thomas Paul Bogaard, MD
- Specialist
- Los Angeles, CA
National Provider Identifier
1861438004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G21222
- Practice address
- 1401 S Grand Ave
Los Angeles, CA 90015-3010 - Phone
- (213) 802-0100
- Fax
- (626) 795-3229
- NPI assigned
- Jun 22, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | G21222 | CA | |
| Specialist | 174400000X | G21222 | CA | Primary |
Addresses
Primary practice location
1401 S Grand Ave
Los Angeles, CA 90015-3010
Mailing address
PO Box 1004
Sierra Madre, CA 91025-4004
Phone (818) 378-1025
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G21220 | Medicaid | CA | |
| RHD113967 | Other | CA | X-RAY LC |
| 00G21220 | Other | CA | CCS |
| 05D0726009 | Other | CA | CLIA NO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051222000703 | CA | Practitioner - Urology | 2961470794 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G21222 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1861438004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1004",
"city": "SIERRA MADRE",
"state": "CA",
"postal_code": "910254004",
"telephone_number": "818-378-1025",
"fax_number": "626-795-3229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 S GRAND AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900153010",
"telephone_number": "213-802-0100",
"fax_number": "626-795-3229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGAARD",
"first_name": "THOMAS",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2023-03-07",
"certification_date": "2020-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "CA",
"license": "G21222",
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G21222",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G21220",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "X-RAY LC",
"identifier": "RHD113967",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CCS",
"identifier": "00G21220",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA NO",
"identifier": "05D0726009",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.