Individual provider Active NPI

William T Boyle, PA-C

  • Physician Assistant
  • San Bernardino, CA
National Provider Identifier
1124053715
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA11057 Issued in CA
Practice address
401 E Highland Ave
Suite 251
San Bernardino, CA 92404-3803
Phone
(909) 881-1614
Fax
(909) 881-2711
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA11057 CA Primary

Addresses

Primary practice location

401 E Highland Ave
Suite 251
San Bernardino, CA 92404-3803

Mailing address

401 E Highland Ave
Suite 251
San Bernardino, CA 92404-3803
Phone (909) 881-1614

Other identifiers 1

IdentifierTypeStateIssuer
PA11057OtherCALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA11057CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation Past Accepting new patients

Organizations & group practices 1

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124053715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE",
            "address_2": "SUITE 251",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043803",
            "telephone_number": "909-881-1614",
            "fax_number": "909-881-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE",
            "address_2": "SUITE 251",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043803",
            "telephone_number": "909-881-1614",
            "fax_number": "909-881-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYLE",
        "first_name": "WILLIAM",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA11057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA11057",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.