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JACOB AVRAM BOOMGAARDT DO
NPI 1508353764
Student in an Organized Health Care Education/Training Program in Charlottesville, VA

Active since April 13, 2018PECOS Enrolled
1215 LEE ST, CHARLOTTESVILLE, VA 22908(434) 924-3627 Get Directions Write a Review

NPPES record last updated: April 13, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jacob Avram Boomgaardt Do NPPES

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

JACOB AVRAM BOOMGAARDT DO (NPI 1508353764) is an individual student in an organized health care education/training program in Charlottesville, Virginia and active in the NPI registry since April 2018. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1508353764
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJACOB AVRAM BOOMGAARDTCredential: DO
Location Address1215 LEE STCharlottesville, VA 22908-0816
Mailing Address8141 Sw 24th Ct Apt 205Davie, FL 33324-5719 · (954) 599-2199
Phone(434) 924-3627
Sole ProprietorNo
Enumeration DateApril 13, 2018
✔ NPI 1508353764 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1215 LEE ST, Charlottesville, VA 22908
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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 (PECOS)

Jacob Avram Boomgaardt Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Other Providers at the Same Location NPPES 20

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

KATHY JEAN FRASE CRNA
Nurse Anesthetist, Certified Registered
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 982-0655
STEVEN R MILLER RPH
Pharmacist
1215 LEE ST, UVA MEDICAL CENTER OUTPATIENT PHARMACY
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-9041
DR. JENNIFER DAWN MARLER M.D.
Radiology (Diagnostic Radiology)
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 982-0428
BARBARA JEAN KOROL CRNA
Nurse Anesthetist, Certified Registered
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-8344
VICTORIA MARIE DANILICH CRNA
Nurse Anesthetist, Certified Registered
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-8344
GLENN S MCKAY MD
Student in an Organized Health Care Education/Training Program
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-2047
MATTHEW B CRIST MD
Student in an Organized Health Care Education/Training Program
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-2047
DAVID C SCALZO MD
Student in an Organized Health Care Education/Training Program
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-2047

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Boomgaardt's NPI number?

The NPI number for Jacob Boomgaardt is 1508353764. It was assigned to this individual provider in the NPPES registry on April 13, 2018.

Where is Jacob Boomgaardt located?

Jacob Boomgaardt practices at 1215 Lee St, Charlottesville, VA 22908. The listed phone number is (434) 924-3627.

What is Jacob Boomgaardt's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jacob Boomgaardt enrolled in Medicare?

Yes. Jacob Boomgaardt is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacob Boomgaardt was last updated on April 13, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.