Boardman Surgical LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

BOARDMAN SURGICAL LLC

Practice address

15074 SE Bevington Ave
Milwaukie, OR 97267-3357

Phone

(503) 307-0159

NPI assigned

Feb 2, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ellie Boardman, CSFANPI 1346839347

Title

Owner

Phone

(503) 307-0159

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ellie Raines Boardman

  • Surgical Physician Assistant
  • Milwaukie, OR
  • NPI 1346839347

  Surgical Assistant

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1033700059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15074 SE BEVINGTON AVE",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972673357",
            "telephone_number": "503-307-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15074 SE BEVINGTON AVE",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972673357",
            "telephone_number": "503-307-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARDMAN SURGICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A",
        "authorized_official_last_name": "BOARDMAN",
        "authorized_official_first_name": "ELLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-307-0159",
        "authorized_official_credential": "CSFA"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Ruth Blatchford, DMD
• Jonathan M. Blatt, M.D.
• Natasha Diane Bledsoe, MA SLP
• Jaclyn Lee Bloom, COTA
• Blossom Midwifery LLC
• Ellie Raines Boardman
• Samantha Bobbitt
• Body Works Wellness Center LLC
• Jaylene Amber Boggs, CERTIFIED OCCUPATION
• Casey Frances Bohannon, CADC III, QMHP , MS

• Surgical Physician Assistant in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Surgical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.