Individual provider Active NPI

Richard Anthony Boada, M.D.

  • Pediatrics Physician
  • Jeffersonville, IN
National Provider Identifier
1891870218
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01050219A Issued in IN
Practice address
3118 E 10TH St Ste B
Jeffersonville, IN 47130-5904
Phone
(812) 285-4585
Fax
(812) 284-2798
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01050219A IN Primary
Pediatrics Physician 208000000X 32419 KY

Addresses

Primary practice location

3118 E 10TH St Ste B
Jeffersonville, IN 47130-5904

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 588-9490

Other identifiers 3

IdentifierTypeStateIssuer
IN4465001OtherINMEDICARE
200209820MedicaidIN
64324197MedicaidKY

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rboada56720@direct.nortonhealthcare.org
FHIR URL https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140320000074 IN Practitioner - Pediatric Medicine 3577794387 Reassigns benefits to 2 organizations
I20161101000621 KY Practitioner - Pediatric Medicine 3577794387 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01050219AINMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children'S Medical Group, LLC Current Accepting new patients
Community Medical Associates, Inc. Pediatrics CurrentSince Oct 2, 2013 Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Mar 1, 2020 Accepting new patients
Community Medical Associates, Inc. CurrentSince Aug 30, 2016 Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Jan 1, 2020 Accepting new patients
Community Medical Associates, Inc. CurrentSince Oct 2, 2013 Accepting new patients
Norton Childrens Medical Group, LLC Pediatrics CurrentSince Jan 1, 2020 Accepting new patients
Community Medical Associates, Inc. Pediatrics Past Accepting new patients

Locations

2051 Clevidence Blvd
Ste B
Clarksville, IN 47129
Phone (502) 629-2030

2051 Clevidence Blvd
Clarksville, IN 47129
Phone (812) 280-6650

3118 E 10th St
Ste B
Jeffersonvlle, IN 47130
Phone (812) 282-6979

1373 E State Road 62
#6F
Madison, IN 47250
Phone (502) 629-7181

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

Interoperability endpoints

  • Direct secure messaging: rboada56720@direct.nortonhealthcare.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1891870218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776879",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776879",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3118 E 10TH ST STE B",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471305904",
            "telephone_number": "812-285-4585",
            "fax_number": "812-284-2798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOADA",
        "first_name": "RICHARD",
        "middle_name": "ANTHONY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01050219A",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "32419",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "IN4465001",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200209820",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64324197",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rboada56720@direct.nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "3118 E 10th St",
            "address_2": "Suite B",
            "city": "Jeffersonville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "471305904",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3118 E 10th St",
            "address_2": "Suite B",
            "city": "Jeffersonville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "471305904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jeffersonville, IN

Sources for this page

Verify at the official NPI Registry.