Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Timothy Lewis Boomer, PA-C

Individual provider Surgical Physician Assistant · NPI 1710230172

Timothy Lewis Boomer, PA-C is a Physician Assistant in Lubbock, Texas. Qualified in 2012, 14 years ago. Practices with James Todd Rose MD PA, a 2-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
14
Licensed in
TX
In the registry since
2012
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

4417 71st St Ste 42
Lubbock, TX 79424-2394
Phone: (806) 799-2991
Fax: (806) 793-5331
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X
Surgical Physician Assistant Taxonomy 363AS0400X (TX)

Record details

NPI number1710230172
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 23, 2012
Last updated in NPPESFebruary 16, 2024
Certification dateFebruary 16, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice James Todd Rose Md Pa — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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