Kimberly Boerner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6348 Issued in AZ

Practice address

2777 E Camelback Rd Ste 140
Phoenix, AZ 85016-4351

Phone

(480) 946-7939

Fax

(480) 946-5258

NPI assigned

Apr 12, 2016

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

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: kimberlyboerner@ad.allscriptsdirect.net

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.

• Center for Dermatology, PLLC

  • Dermatology Physician
  • Scottsdale, AZ
  • NPI 1194792416
  Medicare reassignment
• Center for Dermatology, PLLC

  • Medical Physician Assistant
  • Scottsdale, AZ
  • NPI 1174062673
  NPD (past)
• Richard Lee Averitte Jr., PLLC

  • Non-Pharmacy Dispensing Site
  • Anthem, AZ
  • NPI 1619428851
  NPD (past)
• Southwest Skin Specialists LLC

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1174521926
  NPD (past)

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1922462225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9909 E PARADISE DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852605920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2777 E CAMELBACK RD STE 140",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164351",
            "telephone_number": "480-946-7939",
            "fax_number": "480-946-5258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2777 E Camelback Rd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850164347",
            "country_code": "US",
            "telephone_number": "480-946-7939",
            "fax_number": "480-946-5258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9909 E Paradise Dr",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852605920",
            "country_code": "US",
            "telephone_number": "480-529-0965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOERNER",
        "first_name": "KIMBERLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-12",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Georgiana Marie Boeckmann, PHARMD
• Richard Ronald Boeckmann, PT
• Jordin Nichole Boehlke, CBT
• Stephen Odell Boehning
• Zachary Boente, D.P.T.
• Jessa Lauren Boertje
• Varina Louise Boerwinkle, M.D.
• Mark D Boesen, PHARM.D.
• Mona Boewe, MC, LAC
• Charles Bofah-Konadu, BSN, RN

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; 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.