Individual provider Active NPI

Camerica S. Boma, CRNA

  • Certified Registered Nurse Anesthetist
  • Frederick, MD
National Provider Identifier
1881862258
Registry record updated Apr 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AC000517 Issued in MD
Practice address
45 Thomas Johnson Dr
Suite 207
Frederick, MD 21702-4425
Phone
(301) 694-3400
Fax
(301) 694-3620
NPI assigned
Feb 19, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X AC000517 MD Primary

Addresses

Primary practice location

45 Thomas Johnson Dr
Suite 207
Frederick, MD 21702-4425

Mailing address

PO Box 790058
Saint Louis, MO 63179-0058
Phone (636) 549-2380

Other identifiers 4

IdentifierTypeStateIssuer
KBC1CHOtherMDCAREFIRST BCBS
4191765 00MedicaidMD
S417 0025OtherDCCAREFIRST BCBS
P00745067OtherMDMEDICARE RAILROAD

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
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
AC000517MDMDCertified Registered Nurse Anesthetist

NPI Registry JSON

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271721600000",
    "number": "1881862258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790058",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631790058",
            "telephone_number": "636-549-2380",
            "fax_number": "314-569-5974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 THOMAS JOHNSON DR",
            "address_2": "SUITE 207",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024425",
            "telephone_number": "301-694-3400",
            "fax_number": "301-694-3620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMA",
        "first_name": "CAMERICA",
        "middle_name": "S.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-19",
        "last_updated": "2010-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MD",
            "license": "AC000517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "KBC1CH",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4191765 00",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "S417 0025",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00745067",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2010; 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.