Boomer 06, PLLC
NPI 1871126383ActiveOrganization· Physical Therapist· Oklahoma City, OK
Physical Therapist in Oklahoma City, Oklahoma, registered in NPPES in February 2020. The authorized official on file is Ryan Edward Elassal, Physical Therapist. Enrolled in Medicare as dme supplier - independently-practicing physical therapist and part b supplier - physical/occupational therapy group in private practice.
Overview
| NPI | 1871126383 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 13, 2020 |
| Last updated in NPPES | Oct 22, 2024 |
| Certified by provider | Oct 22, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — |
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 DME Supplier - Independently-Practicing Physical Therapist (OK); Part B Supplier - Physical/Occupational Therapy Group in Private Practice (OK) |
|---|
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