Anita Boulom, PA-C
NPI 1184213555ActiveIndividual· Physician Assistant· Janesville, WI
Physician Assistant (PA-C) in Janesville, Wisconsin, trained at University of North Texas Hsc, College of Osteopathic Med (class of 2020). 209 Medicare patients in 2024, $11,842 paid; nearly all of their 313 Part D prescriptions were generic (92%).
Overview
| NPI | 1184213555 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA-C |
| Sole proprietor | No |
| NPI issued | Jan 11, 2021 |
| Last updated in NPPES | Jan 11, 2021 |
| Certified by provider | Jan 11, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 5192-23 | WI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (WI) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 209 |
|---|---|
| Services billed | 240 across 22 procedure codes |
| Paid by Medicare | $11,842 |
Part D prescriptions in 2024
| Prescriptions (claims) | 313 · 316 30-day fills |
|---|---|
| Patients | 233 |
| Total drug cost | $5,466 |
| Generic share | 92% of claims |
Education and affiliations
| Medical school | University of North Texas Hsc, College of Osteopathic Med |
|---|---|
| Graduation year | 2020 |
| Medicare specialty | Physician Assistant |
Medical group
- Mercy Health System CorporationJanesville, WI · 753 clinicians
Hospital affiliation
- Mercy Health System CorpJanesville, WI
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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