Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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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
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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

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at James Todd Rose MD PA

Clinicians the CMS Doctors & Clinicians file lists under the same group practice.

Other providers in Lubbock