Active NPI
Ronda Bouwens, M.D.
- Family Medicine Physician
- Port Angeles, WA
National Provider Identifier
1104805134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 42021-20
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59964 | AZ | MD | Family Medicine Physician |
| 61062895 | WA | MD | Family Medicine Physician |
| 42021-20 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| District Medical Group, Inc | Current | Accepting new patients | |
| District Medical Group, Inc | Current | 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
- rbouwens252552@direct.valleywisehealth.org
- 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.
-
- Anatomic Pathology & Clinical Pathology Physician
- Phoenix, AZ
- NPI 1336472448
-
- Emergency Medicine Physician
- Phoenix, AZ
- NPI 1144624339
-
- Gastroenterology Physician
- Phoenix, AZ
- NPI 1356674469
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.