Shawn C Boehm, DDS,MD

Primary specialty

DentistTaxonomy code 122300000X

License

2018019668 Issued in MO

Practice address

3109 Frederick Avenue
Suite a
St Joseph, MO 64506

Phone

(816) 364-4774

Fax

(816) 364-4373

NPI assigned

May 22, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• 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.

• Swope Health Services

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
  • NPI 1689760076
  Medicare reassignment NPD
• Northwest Missouri Oral & Maxillofacial Surgeons

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Joseph, MO
  • NPI 1154485613
  NPD
• Swope Health Services

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
  • NPI 1285404434
  NPD

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

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763424000000",
    "number": "1902397250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3109 FREDERICK AVENUE",
            "address_2": "SUITE A",
            "city": "ST JOSEPH",
            "state": "MO",
            "postal_code": "64506",
            "telephone_number": "816-364-4774",
            "fax_number": "816-364-4373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 FREDERICK AVENUE",
            "address_2": "SUITE A",
            "city": "ST JOSEPH",
            "state": "MO",
            "postal_code": "64506",
            "telephone_number": "816-364-4774",
            "fax_number": "816-364-4373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEHM",
        "first_name": "SHAWN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS,MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-22",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2018019668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400056658",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• BLKC, Inc. (D/B/a Premier Compounding Pharmacy)
• Blue Hat LLC
• Zach Robert Boal, MD
• Bob Ruwwe Jr. DDS PC
• Kenneth Pacana Boc, MD
• Patricia A. Boice, D.D.S., M.S.
• Bonebrake Vision & Eye Center LLC
• John S Bonebrake, O.D.
• Beth L Booker, RN, BC, FNP
• Linda A Borger, SLP-CCC

• Dentist in St Joseph, MO
• Providers in St Joseph, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2025; 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.