Individual provider Active NPI

Ronda Bouwens, M.D.

  • Family Medicine Physician
  • Port Angeles, WA
National Provider Identifier
1104805134
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
42021-20 Issued in WI
Practice address
939 Caroline St
Port Angeles, WA 98362-3909
Phone
(360) 471-7000
NPI assigned
Jan 9, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 61062895 WA
Family Medicine Physician 207Q00000X 59964 AZ
Family Medicine Physician 207Q00000X 42021-20 WI Primary

Addresses

Primary practice location

939 Caroline St
Port Angeles, WA 98362-3909

Mailing address

939 Caroline St
Port Angeles, WA 98362-3909
Phone (360) 417-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230222002589 AZ Practitioner - Family Practice 2062696768 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
59964AZMDFamily Medicine Physician
61062895WAMDFamily Medicine Physician
42021-20WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
District Medical Group, Inc CurrentSince Feb 1, 2023 Accepting new patients
District Medical Group, Inc CurrentSince Feb 1, 2023 Accepting new patients
District Medical Group, Inc Current Accepting new patients

Locations

8088 W Whitney Dr
Peoria, AZ 85345
Phone (602) 655-2000

2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

Interoperability endpoints

  • Direct secure messaging: rbouwens252552@direct.valleywisehealth.org
  • Direct secure messaging: rbouwens1255091@wm.providencedirect.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1104805134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "939 CAROLINE ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983623909",
            "telephone_number": "360-417-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 CAROLINE ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983623909",
            "telephone_number": "360-471-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUWENS",
        "first_name": "RONDA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-09",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "61062895",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "59964",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "42021-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

Verify at the official NPI Registry.