MITRA B. BOODRAM MD – NPI #1174537039
Radiology

A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children.

Health Care Provider Taxonomy Code for Radiology

MITRA BOODRAM is a radiologist located in SAINT LOUIS, MO. NPPES has assigned the NPI number 1174537039 to MITRA BOODRAM on July 28, 2006. It is a Type-1 NPI, indicating this NPI number is associated with an individual. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 2085N0700X from the Health Care Provider Taxonomy code set, which is classified as Radiology, specializing in Neuroradiology

The NPI profile was last updated on Apr 15, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MITRA BOODRAM below.

NPI Profile for
MITRA B. BOODRAM

NPI Number
1174537039
Enumeration Date

(about 20 years ago)
Entity Type
Type-1  Individual (Male)
Legal Name
MITRA B. BOODRAM
Credentials
MD
Primary location
11133 DUNN RD
DEPT RADIOLOGY
SAINT LOUIS, MO 63136-6163
Phone: (314) 362-7200 Fax: (314) 747-4189
Mailing address
PO BOX 7412011
CHICAGO, IL 60674-2011
Phone: (314) 362-7200 Fax: (314) 747-4189
Sole Proprietor
No
Updated
Identifiers

Identifiers for MITRA BOODRAM

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidMO208285007
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2085N0700X
- Radiology / Neuroradiology (Primary)		 MO 110362
2085R0202X
- Radiology / Diagnostic Radiology		 MO 110362

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Endpoint

Health Information Exchange (HEI)

HEI is the mobilization of health care information electronically across organizations within a region, community or hospital system. Endpoints provide a simple and secure way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet such as primary care physicians, specialists, hospitals, labs, etc.

Endpoint
https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Endpoint type
FHIR URL
Endpoint Description
Content Type
Affiliation
Y
Endpoint Location
11133 DUNN RD,
SAINT LOUIS, MO 77025-1669

Additional Information

Accepts Medicare
This provider accepts Medicare-approved amount as payment in full. The Medicare-approved amount is the total the provider can be paid. When a provider accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible & coinsureance.
Medicare Ordering & Referring
Provider can:
  • Refer to Part B
  • Order Durable Medical Equipment
  • Refer to Home Health Agency
  • Order Power Mobility Devices
Affiliations
MITRA BOODRAM is affiliated with the following medical group(s):
  • HOSPITAL
    • ALTON MEMORIAL HOSPITAL
      ONE MEMORIAL DRIVE
      ALTON, IL 62002
    • CHRISTIAN HOSPITAL NORTHEAST
      11133 DUNN ROAD
      SAINT LOUIS, MO 63136

Why is my NPI data (personal information) being displayed publicly?
If you have an active NPI profile, your profile is required to be disclosed according to the FOIA and eFOIA. HIPAA also requires covered providers to share their NPI with other providers, health plans, clearinghouses and any entity that may need it for billing purposes.

How do I correct or change the NPI data displayed here?
At any time, providers can make changes to their NPI profile at NPPES. Login to NPPES to make changes online or call (800) 465-3203 for assistance. Changes made at NPPES will be reflected on this web site within a few days.

Can I hide my NPI profile from the public?
Unfortunately, No. The NPPES discloses health care provider data under the Freedom of Information Act to the public, which means anyone may request such information directly from the National Plan & Provider Enumeration System. See the complete CMS Data Dissemination Notice here.