BRIAN L BOOMGARDEN MS CADC
NPI 1871510677
Counselor - Mental Health in Manitowoc, WI

Q: What is Brian Boomgarden's NPI number?

The NPI number for Brian Boomgarden is 1871510677. It was assigned to this individual provider in the NPPES registry on July 16, 2006.

Q: What is Brian Boomgarden's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Brian Boomgarden was last updated on June 3, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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 July 16, 2006PECOS EnrolledAccepts Medicare Assignment

339 REED AVE, MANITOWOC, WI 54220(920) 320-8600(920) 320-8662 Get Directions Write a Review

NPPES record last updated: June 3, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Brian L Boomgarden Ms Cadc NPPES

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

BRIAN L BOOMGARDEN MS CADC (NPI 1871510677) is an individual mental health provider in Manitowoc, Wisconsin, licensed in Wisconsin (2898-123) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1988).

NPPES Registry Identity

NPI1871510677

Entity TypeIndividualMale

Primary Taxonomy101YM0800X

Provider Legal NameBRIAN L BOOMGARDENCredential: MS CADC

Location Address339 REED AVEManitowoc, WI 54220-2020

Mailing AddressPo Box 2290Manitowoc, WI 54221-2290 · (920) 320-8600 · Fax (920) 320-8662

Phone(920) 320-8600

Fax(920) 320-8662

Sole ProprietorNo

Medical School CMSOtherGraduated 1988

Enumeration DateJuly 16, 2006

Last NPPES UpdateJune 3, 2008

✔ NPI 1871510677 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in WI · 2898-123

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 11165 (WI)

339 REED AVE, Manitowoc, WI 54220

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Other Identifiers 3

Other13647Network Health Plan

Other390806395Cigna

Medicaid39647200WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, HealthPartners, Medica and more.Insurance ›

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

Brian L Boomgarden Ms Cadc 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 ID1355784372

PECOS Enrollment IDI20240207000779

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 15

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

MICHAEL G ADERMAN PMHNP

Nurse Practitioner (Psychiatric/Mental Health)