NPIMap

Individual provider Active NPI

Brian Michael Boldt, D.O.

  • Diagnostic Radiology Physician
  • Tacoma, WA
National Provider Identifier
1144480245
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
OP60104328 Issued in WA
Practice address
1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900
Phone
(253) 761-4200
NPI assigned
Jun 11, 2008
Last updated
Aug 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X OP60104328 WA Primary

Addresses

Primary practice location

1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900

Mailing address

1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900
Phone (253) 761-4200

Other practice location 1

Madigan Army Medical Ctr Department Of
9040 Fitzsimmons Drive
Tacoma, WA 98431-0001
Phone (253) 968-5604

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171102001530 WA Practitioner - Diagnostic Radiology 6608007091 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Union Avenue Open MRI LLCGroup PAC ID 5597652917, 44 clinicians
Tra-Minw P SGroup PAC ID 2163316167, 152 clinicians

Practice addresses (Care Compare)

11212 Sunrise Blvd E
Suite 200
Puyallup, WA 98374-8847
Phone (253) 841-4353

222 15TH Ave SE
Puyallup, WA 98372-3754
Phone (253) 841-4353

2502 S Union Ave
Tacoma, WA 98405-1328
Phone (253) 841-4353

4455 Logan Dr NE
Lacey, WA 98516-1351
Phone (253) 841-4353

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OP60104328WAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Jul 1, 2022 Accepting new patients
Tra-Minw P S CurrentSince Jul 1, 2022 Accepting new patients
Tra Medical Imaging Centers LLC CurrentSince Dec 1, 2025 Accepting new patients
Union Avenue Open MRI LLC CurrentSince Jul 1, 2022 Accepting new patients
American Diagnostics Services LLC Past Accepting new patients

Locations

34515 9th Ave S
Federal Way, WA 98003
Phone (253) 835-8100

222 15th Ave SE
Puyallup, WA 98372

1304 Fawcett Ave
Ste 100
Tacoma, WA 98402
Phone (253) 680-3372

2502 S Union Ave
Tacoma, WA 98405
Phone (253) 759-5900

3402 S 18th St
Tacoma, WA 98405
Phone (253) 383-1099

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ei-trami

Organizations & group practices 5

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

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1144480245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021900",
            "telephone_number": "253-761-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021900",
            "telephone_number": "253-761-4200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Madigan Army Medical Ctr Department Of",
            "address_2": "9040 Fitzsimmons Drive",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984310001",
            "country_code": "US",
            "telephone_number": "253-968-5604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLDT",
        "first_name": "BRIAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-11",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "OP60104328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.