CHERYL R BOURGAULT (NPI# 1205823036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205823036 |
| Entity Type | Individual |
| Full Name | CHERYL R BOURGAULT |
| Credential | PA C |
| Practice Address |
360 S Garden Way Suite 210 Eugene OR 97401-8173 |
| Mailing Address |
Po Box 10605 360 S Garden Way, Suite 210 Eugene OR 97440-2605 |
| Practice Telephone | 5416833202 |
| Practice Fax Number | 5418681063 |
| Mailing Telephone | 5416833202 |
| Mailing Fax Number | 5418681063 |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2010-10-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA10004248 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | L & I | 0203556 | 01 |
| WA | REGENCE BC/BS | 6445B0 | 01 |
| WA | CHPW | 8409955 | 01 |
| WA | 8409955 | 05 | |
| COMMERCIAL | 911019392 | 01 |
| Street Address |
360 S GARDEN WAY SUITE 210 |
| City | EUGENE |
| State | OR |
| Zip Code | 97401-8173 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558692566 | Taylor Hamilton Bushnell | Physical Therapist | 360 S Garden Way, Suite 250, Eugene, OR 97401-8173 | 2010-01-15 |
| 1528243110 | Willamette Community Medical Group LLC | Durable Medical Equipment & Medical Supplies | 360 S Garden Way, Suite 290, Eugene, OR 97401-8173 | 2008-01-02 |
| 1811067069 | Christy S. Mcallister | Physician Assistant | 360 S Garden Way, Suite 230, Eugene, OR 97401-8173 | 2006-11-08 |
| 1710065271 | Joyce M Brackebusch | Otolaryngology | 360 S Garden Way, Suite 200, Eugene, OR 97401-8173 | 2006-11-01 |
| 1972696755 | Andrew Craig Mcivor | Surgery | 360 S Garden Way, Suite 290, Eugene, OR 97401-8173 | 2006-10-02 |
| 1457458192 | Troy K. Richey | Dermatology | 360 S Garden Way, Ste 230, Eugene, OR 97401-8187 | 2006-09-17 |
| 1811920366 | Middle Fork Surgery Center LLC | Clinic/Center | 360 S Garden Way, Suite 100, Eugene, OR 97401-8173 | 2006-07-08 |
| 1750330262 | Thomas P. Stites | Surgery | 360 S Garden Way, Suite 290, Eugene, OR 97401-8173 | 2006-05-10 |
| 1275500829 | Susan L. Detels | Audiologist-Hearing Aid Fitter | 360 S Garden Way, Suite 200, Eugene, OR 97401-8173 | 2006-03-02 |
| 1114906443 | John M Terhes | Specialist | 360 S Garden Way, Suite 290, Eugene, OR 97401-8173 | 2006-01-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427681709 | Sarah Voigt | Counselor | 2149 Centennial Plaza Suite #4, Eugene, OR 97401 | 2020-02-14 |
| 1801426242 | Therapeutic Associates, Inc. | Physical Therapist | 760 Charnelton St., Suite 760, Eugene, OR 97401 | 2020-01-24 |
| 1225676232 | Aaron James Barber | Massage Therapist | 1375 Pearl St, Eugene, Or 97401, Eugene, OR 97401 | 2019-12-20 |
| 1851957047 | Altru Home Care LLC | Nursing Care | 1345 Olive St., Eugene, OR 97401 | 2019-05-14 |
| 1881155208 | Herron Jordanna Spence | Speech-Language Pathologist | 385 West 2nd Ave., Eugene, OR 97401 | 2019-03-28 |
| 1750855094 | Brandon Marshall | Counselor | 1158 High St Ste 202, Eugene, OR 97401 | 2019-01-21 |
| 1881172591 | Kayla Nicole O'brien | Nurse Practitioner | Country Club In Eugene, 520 Country Club Road, Eugene, OR 97401 | 2018-08-03 |
| 1962992180 | Shannon Jensen Smyth | Counselor | Va Eugene Downtown Clinic, 211 E. 7th Ave, Eugene, OR 97401 | 2018-05-14 |
| 1902305956 | Christine Noel Gray | Peer Specialist | 499 W. 4th Ave, Eugene, OR 97401 | 2018-02-06 |
| 1821507344 | Anjuli Chitkara | Psychologist | 1679 Willamette Street, Eugene, OR 97401 | 2017-09-27 |
| Find all providers in zip 97401 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871133322 | Kim Fox | Physician Assistant | 1292 High St Ste 224, Eugene, OR 97401-3238 | 2020-01-13 |
| 1881112910 | Patrick Russell Tutt | Physician Assistant | 2596 City View St, Eugene, OR 97405-1443 | 2017-09-08 |
| 1598139800 | Sean Malanowski | Physician Assistant | 1200 Hilyard St Ste 620, Eugene, OR 97401-8157 | 2015-11-24 |
| 1346617792 | Marissa Reen | Physician Assistant | 360 S Garden Way Ste 290, Eugene, OR 97401-8175 | 2015-09-01 |
| 1780918847 | Ryan Lee Cain | Physician Assistant | 4040 W 11th Ave Ste B, Eugene, OR 97402-5601 | 2009-09-22 |
| 1023292067 | Chelsea Genna Marshall | Physician Assistant | 1861 Kingsley Rd. #80, Eugene, OR 97401 | 2007-12-27 |
| 1245326651 | Lisa Marlene Olson | Physician Assistant | 330 S Garden Way Ste 390, Eugene, OR 97401-8179 | 2006-10-04 |
| 1881621381 | Jan K Lintz | Physician Assistant | 3525 Hilyard St Ste 600, Eugene, OR 97405-3866 | 2006-06-28 |
| 1154309326 | Nathan Bryan Smith | Physician Assistant | 743 Country Club Rd, Eugene, OR 97401-6019 | 2006-01-06 |
| 1538147053 | Lisa M Ingold | Physician Assistant | 360 S Garden Way Ste 230, Eugene, OR 97401-8187 | 2006-01-04 |
| Find all providers in EUGENE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.