MRS. ANITA BOULOM PA-C
NPI 1184213555
Physician Assistant in Janesville, WI

Q: What is Anita Boulom's NPI number?

The NPI number for Anita Boulom is 1184213555. It was assigned to this individual provider in the NPPES registry on January 11, 2021.

Q: What is Anita Boulom's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Anita Boulom was last updated on January 11, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 11, 2021PECOS EnrolledAccepts Medicare Assignment

3400 DEERFIELD DR, JANESVILLE, WI 53546(608) 314-3600 Get Directions Write a Review

NPPES record last updated: January 11, 2021. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Mrs. Anita Boulom Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. ANITA BOULOM PA-C (NPI 1184213555) is an individual physician assistant in Janesville, Wisconsin, licensed in Wisconsin (5192-23) and active in the NPI registry since January 2021. She is enrolled in Medicare PECOS, is affiliated with Mercy Health System Corp, and is a graduate of University Of North Texas Hsc, College Of Osteopathic Med (2020).

NPPES Registry Identity

NPI1184213555

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMRS. ANITA BOULOMCredential: PA-C

Location Address3400 DEERFIELD DRJanesville, WI 53546-3557

Mailing Address700 University Bay Dr Apt 315Madison, WI 53705-2268 · (469) 348-5497

Phone(608) 314-3600

Sole ProprietorNo

Medical School CMSUniversity Of North Texas Hsc, College Of Osteopathic MedGraduated 2020

Enumeration DateJanuary 11, 2021

NPPES CertifiedJanuary 11, 2021

✔ NPI 1184213555 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in WI · 5192-23

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

3400 DEERFIELD DR, Janesville, WI 53546

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Anita Boulom Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8921415829

PECOS Enrollment IDI20210319001875

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

128 services124 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

28 services28 patients

Emergency department visit with moderate level of medical decision making 99284

An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.

27 services27 patients

Emergency department visit with high level of medical decision making 99285

An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.

18 services18 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

11 services11 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Mercy Health System Corp

Acute Care Hospitals · Janesville, WI

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520066

Location1000 Mineral Point AveJanesville, WI 53548 · Rock County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53546 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ERIKA R BROWN

Nurse Practitioner