BOOMER MEDICAL CLINIC (NPI# 1538458351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538458351 |
| Entity Type | Organization |
| Organization Name | BOOMER MEDICAL CLINIC |
| Practice Address |
3525 Watt Ave Sacramento CA 95821 |
| Mailing Address |
Po Box 1939 Carmichael CA 95609-1939 |
| Practice Telephone | 9164800707 |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2012-02-20 |
| Authorized Official Name | DR. KIMBERLY LE (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9164800707 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | A46083 | CA | Allopathic & Osteopathic Physicians |
| Y | 2081P0004X |
Physical Medicine & Rehabilitation Specialization: Spinal Cord Injury Medicine |
G72879 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
3525 WATT AVE |
| City | SACRAMENTO |
| State | CA |
| Zip Code | 95821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972100717 | Denise Renee Landgraf | Licensed Vocational Nurse | 3615 Marconi Ave, Sacramento, CA 95821 | 2020-10-05 |
| 1770053258 | Oksana A Shutkova | Behavior Technician | 2823 El Camino Avenue, Appt #19, Sacramento, CA 95821 | 2018-11-28 |
| 1871063420 | Otto Bock Orthopedic Services LLC | Durable Medical Equipment & Medical Supplies | 3800 Watt Avenue Suite 151, Sacramento, CA 95821 | 2018-11-27 |
| 1386123438 | Rene William Villanueva | Marriage & Family Therapist | 3650 Auburn Blvd Bldg C-208, Sacramento, CA 95821 | 2018-08-09 |
| 1558853135 | Behavioral Health Solutions of The Pacific | Clinic/Center | 2829 Watt Avenue, Suite 200, Sacramento, CA 95821 | 2018-05-31 |
| 1679064091 | Carrissa Jean Angelique Bishop | Counselor | 3550 Watt Avenue, Suite 140, Sacramento, CA 95821 | 2018-05-21 |
| 1164943049 | Vanessa Selene Tinajero | Social Worker | 3615 Macorni Ave, Sacramento, CA 95821 | 2017-06-30 |
| 1316488562 | Lucas Hansen | Student in an Organized Health Care Education/Training Program | 3007 Clairidge Oak Ct, Sacramento, CA 95821 | 2017-03-20 |
| 1215383054 | Mark Brufladt | Physical Therapy Assistant | 3548 Ardmore Rd, Sacramento, CA 95821 | 2016-05-11 |
| 1053782789 | Marianna Jakucska | Marriage & Family Therapist | 2740 Fulton Ave Ste 100c, Sacramento, CA 95821 | 2015-10-07 |
| Find all providers in zip 95821 | ||||
| Taxonomy Code | 2081P0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Spinal Cord Injury Medicine |
| A physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal cord dysfunction by working in an interdisciplinary manner. Care is provided to patients of all ages on a lifelong basis and covers related medical, physical, psychological and vocational disabilities and complications. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. ACGME Accredited Residency Program Requirements: 1 year of training with 3-5 years in relevant specialty for a total of 4-6 years. ABMS Approved Subspecialty Certificate: (Physical Medicine and Rehabilitation) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902046287 | Kim Le | Physical Medicine & Rehabilitation | 3525 Watt Avenue, Sacramento, CA 95821 | 2009-02-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811137557 | Thomas L. Hedge, M.d. A Medical Corporation | Physical Medicine & Rehabilitation | 18300 Roscoe Blvd 4ifl Tower, Northridge, CA 91325-4167 | 2009-02-20 |
| 1184724999 | Doug T Ota | Physical Medicine & Rehabilitation | 3801 Miranda Ave # Mc-128, Palo Alto, CA 94304-1207 | 2006-09-22 |
| 1184736142 | Vandana Punj | Physical Medicine & Rehabilitation | 3801 Miranda Ave # Sci/128, Palo Alto, CA 94304-1207 | 2006-08-31 |
| 1003923020 | Inder Perkash | Physical Medicine & Rehabilitation | 813 Allardice Way, Stanford, CA 94305-1050 | 2006-08-24 |
| 1104931542 | Glenn Mark Balfour | Physical Medicine & Rehabilitation | 785 Grand Ave Ste 218, Carlsbad, CA 92008-2371 | 2006-08-19 |
| 1679533780 | Bea Medical Group, Inc. | Physical Medicine & Rehabilitation | 10070 Pasadena Ave, Ste 2, Cupertino, CA 95014-5942 | 2006-03-23 |
| 1508372772 | Sandhi Wynn | Physical Medicine & Rehabilitation | 5901 E 7th St, Long Beach, CA 90822-5201 | 2017-12-23 |
| 1245775360 | Newport Physical Medicine and Rehabilitation Inc. | Physical Medicine & Rehabilitation | 17264 Red Hill Ave, Irvine, CA 92614-5628 | 2016-12-28 |
| 1720535255 | George T Cyril M.d., Inc | Physical Medicine & Rehabilitation | 13160 Mindanao Way Ste 300, Marina Del Rey, CA 90292-6393 | 2016-09-01 |
| 1689093023 | Travis Edmiston | Physical Medicine & Rehabilitation | 7601 Imperial Hwy, Downey, CA 90242-3456 | 2014-04-14 |
| Find all providers with the same taxonomy | ||||
| City | SACRAMENTO |
| Zip Code | 95821 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.