BOULDER CARE PROVIDER GROUP PA (NPI# 1649838590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1649838590 |
Entity Type | Organization |
Organization Name | BOULDER CARE PROVIDER GROUP PA |
Other Organization Name | BOULDER CARE |
Practice Address |
208 Sw Harvey Milk St Ste 200 Portland OR 97204-2611 |
Mailing Address |
208 Sw Harvey Milk St Suite 200 Portland OR 97204-2611 |
Practice Telephone | 5032085061 |
Mailing Telephone | 5032085061 |
Mailing Fax Number | 8332602594 |
Enumeration Date | 2019-06-04 |
Last Update Date | 2020-11-06 |
Authorized Official Name | DR. ALYSON L SMITH (MEDICAL DIRECTOR) |
Authorized Official Telephone | 7606848535 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Boulder Care | Doing Business As Name - Organization |
Street Address |
208 SW HARVEY MILK ST STE 200 |
City | PORTLAND |
State | OR |
Zip Code | 97204-2611 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1922662352 | Sleep Management, L.L.C. | Respiratory Therapist, Registered | 1050 Sw 6th Avenue, Suite 1100 Office # 52, Portland, OR 97204 | 2019-05-01 |
1588178701 | Daniel Hendrickson | Pharmacist | 503 Sw 5th Avenue, Portland, OR 97204 | 2017-11-27 |
1790133031 | Modupe Desiree Bansile | Counselor | 209 Sw Fourth Ave, Suite 520, Portland, OR 97204 | 2016-05-26 |
1841655834 | Isabella Zaragoza | Counselor | 421 Sw Oak St Suite 520, Portland, OR 97204 | 2015-12-18 |
1952737736 | Hessler-cohen Enterprises LLC | Acupuncturist | 310 Sw 4rth Avenue, Suite 725, Portland, OR 97204 | 2013-09-24 |
1144583378 | Angela Nicole Johnson | Physical Therapist | 555 Sw Oak Street, Portland, OR 97204 | 2012-06-22 |
1255614624 | Jaclyn Rene Jones | Nurse Practitioner | 601 Sw 4th Ave, Portland, OR 97204 | 2011-09-22 |
1407148398 | Cristianne Paulsen | Dental Hygienist | 426 Sw Stark, 9th Floor, Portland, OR 97204 | 2011-05-10 |
1396928255 | Jessica L Hall | Counselor | 421 Sw Oak Street, Suite 520, Portland, OR 97204 | 2007-12-13 |
1699896274 | Julie Anne Oyemaja | Counselor | 421 Sw Oak St., Ste. 210, Portland, OR 97204 | 2007-04-02 |
Find all providers in zip 97204 |
Taxonomy Code | 207QA0401X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Specialization | Addiction Medicine |
A family medicine physician who specializes in the diagnosis and treatment of addictions. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417333535 | Ascension Health Centers | Family Medicine | 8083 Se 13th Ave, Suite #3, Portland, OR 97202-6668 | 2015-07-31 |
1316006166 | Stephen Cameron | Family Medicine | 3449 N Anchor St, Suite 300a, Portland, OR 97217-7679 | 2006-12-07 |
1619538782 | Gabrielle Alyson Bowker | Family Medicine | 17 Bishop St, Portland, ME 04103-2659 | 2019-06-27 |
1558719450 | Ascension Medical Group LLC | Family Medicine | 700 N Hayden Island Dr Ste 100, Portland, OR 97217-8130 | 2016-06-01 |
1073978284 | Robbie Bahl, Md LLC | Family Medicine | 3769 Se Milwaukie Ave, Portland, OR 97202-3804 | 2015-12-15 |
1144648312 | Bradley Michael Buchheit | Family Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2014-04-03 |
1013273861 | Andrea Gough-goldman | Family Medicine | 1030 Ne Couch St, Portland, OR 97232-3067 | 2012-04-05 |
1942522388 | John Henry Hardy Jr. | Family Medicine | 700 N Hayden Island Dr Ste 100, Portland, OR 97217-8130 | 2010-02-26 |
1942469762 | Robbie Bahl | Family Medicine | 3769 Se Milwaukie Ave, Portland, OR 97202-3804 | 2008-06-06 |
1033232996 | Jeffrey Benton Hayes | Family Medicine | 1027 E Burnside St, Portland, OR 97214-1328 | 2007-04-07 |
Find all providers in PORTLAND |
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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.