Kelly Vanderbilt Bomer, M.D.

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

License

30302 Issued in AZ

Practice address

9155 E Bell Rd
Scottsdale, AZ 85260-1521

Phone

(480) 889-8870

Fax

(480) 889-8871

NPI assigned

Aug 4, 2006

Last updated

Dec 20, 2019By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• James J. Bouzoukis, MD, LLC

  • Otolaryngology/Facial Plastic Surgery Physician
  • Scottsdale, AZ
  • NPI 1972783785
  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1871501999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9155 E BELL RD",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852601521",
            "telephone_number": "480-889-8870",
            "fax_number": "480-889-8871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 E BELL RD",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852601521",
            "telephone_number": "480-889-8870",
            "fax_number": "480-889-8871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMER",
        "first_name": "KELLY",
        "middle_name": "VANDERBILT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "AZ",
            "license": "30302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Soozi Bolte, MC
• John J Bolte, D.C.
• Brandi F Bolton, FNP
• Constance Victoria Bolton
• Megan Bomar, DMD
• Marc Albert Bonacci, D.C.
• Christopher S Bonati, M.D.
• Jason T Bond, M.D.
• Mark A Bond, RPH
• Philip Albert Bond, MD

• Facial Plastic Surgery Physician in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Facial Plastic Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; 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.