NPIMap

Individual provider Active NPI

Karl Ekkehard Boellert Jr., M.D., M.P.H.

  • Physical Medicine & Rehabilitation Physician
  • Greenwood, SC
National Provider Identifier
1972731917
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
37144 Issued in SC
Practice address
115 Academy Ave
Greenwood, SC 29646-3869
Phone
(864) 725-7272
Fax
(864) 725-5799
NPI assigned
Jun 29, 2009
Last updated
Dec 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 37144 SC Primary

Addresses

Primary practice location

115 Academy Ave
Greenwood, SC 29646-3869

Mailing address

115 Academy Ave
Greenwood, SC 29646-3869
Phone (864) 725-7272

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kboellert127308@selfregional.direct-ci.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140910000483 SC Practitioner - Physical Medicine and Rehabilitation 9537305487 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians
Self Regional HealthcareGroup PAC ID 4082527742, 159 clinicians

Practice addresses (Care Compare)

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4111

155 Academy Ave
Greenwood, SC 29646-3869
Phone (864) 725-4865

160 Academy Ave
Greenwood, SC 29646-3808
Phone (864) 223-8090

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37144SCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Self Regional Healthcare CurrentSince Feb 2, 2026 Accepting new patients
Self Regional Healthcare CurrentSince Feb 2, 2026 Accepting new patients
Self Medical Group CurrentSince Sep 1, 2014 Accepting new patients
Self Medical Group CurrentSince Sep 1, 2014 Accepting new patients
Self Medical Group Current Accepting new patients
Self Regional Healthcare Past Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

75 Remittance Dr
Dept 6793
Chicago, IL 60675

104 Wells Ave
Greenwood, SC 29646

115 Academy Ave
Greenwood, SC 29646
Phone (864) 725-7272

155 Academy Ave
Greenwood, SC 29646
Phone (864) 725-4865

22580 Highway 76 E
Ste 200
Laurens, SC 29360
Phone (864) 725-1480

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: kboellert127308@selfregional.direct-ci.net

Organizations & group practices 7

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1972731917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 ACADEMY AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463869",
            "telephone_number": "864-725-7272",
            "fax_number": "864-725-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ACADEMY AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463869",
            "telephone_number": "864-725-7272",
            "fax_number": "864-725-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOELLERT",
        "first_name": "KARL",
        "middle_name": "EKKEHARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D., M.P.H.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "SC",
            "license": "37144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kboellert127308@selfregional.direct-ci.net",
            "affiliation": "N",
            "address_1": "115 Academy Ave",
            "city": "Greenwood",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296463869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.