Jacob Otto Boeckmann, MD

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

License

A123972 Issued in CA

Practice address

25500 Rancho Niguel Rd Ste 120
Laguna Niguel, CA 92677-7388

Phone

(949) 273-3112

Fax

(833) 719-8711

NPI assigned

Apr 22, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• University Head & Neck Surgeons

  • Otolaryngology Physician
  • Orange, CA
  • NPI 1669437075
  Medicare reassignment NPD
• University of California Irvine

  • Infusion Therapy Clinic/Center
  • Irvine, CA
  • NPI 1417027475
  NPD (past)
• University of California Irvine

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1689608150
  NPD (past)

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560297600000",
    "number": "1861666703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25500 RANCHO NIGUEL RD STE 120",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926777388",
            "telephone_number": "949-276-3112",
            "fax_number": "833-719-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25500 RANCHO NIGUEL RD STE 120",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926777388",
            "telephone_number": "949-273-3112",
            "fax_number": "833-719-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOECKMANN",
        "first_name": "JACOB",
        "middle_name": "OTTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-22",
        "last_updated": "2019-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "CA",
            "license": "A123972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Peter Blair, D.P.M.
• Mitchell Blecha, PHARMD.
• Lisa Blessing Kice
• Marena Boctor Nakhla, DPT
• Karina Boeckler
• Annie Boon
• Botros & Ghobrial Dental Center
• Jennifer Bouras
• Lawrence Grant Bowser Jr., DC
• Stacy Box

• Facial Plastic Surgery Physician in Laguna Niguel, CA
• Providers in Laguna Niguel, CA by specialty
• Facial Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; 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.

Verify at the official NPI Registry.