Physician Compare National (NPI:1801978259)

HEALTHCARE PROVIDER: ROBERT J BOULWARE MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1801978259
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9335133586
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040415001199
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOULWARE
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF MISSOURI, KANSAS CITY, SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GLADSTONE URGENT CARE, LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1052613007
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	7642 N OAK TRFY
	Group Practice or individual's line 1 address
City	GLADSTONE
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	641181751
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8164681411
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	260096
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTH KANSAS CITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	260177
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NEW LIBERTY HOSPITAL DISTRICT
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	261321
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	HEDRICK MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	260057
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	CAMERON REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y