NPIMap

Individual provider Active NPI

Revaz Boukia, PA-C

  • Physician Assistant
  • Ashland, OR
National Provider Identifier
1144638859
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA228829 Issued in OR
Practice address
280 Maple St
Ashland, OR 97520-1552
Phone
(541) 201-4000
Fax
(541) 488-7437
NPI assigned
Jul 25, 2014
Last updated
May 6, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2026

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 PA228829 OR Primary

Addresses

Primary practice location

280 Maple St
Ashland, OR 97520-1552

Mailing address

2825 E Barnett Rd
MSS
Medford, OR 97504-8332
Phone (541) 789-4281

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230131001739 NV Practitioner - Physician Assistant 4587885371 Reassigns benefits to 2 organizations
I20260511003874 OR Practitioner - Physician Assistant 4587885371 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edwards Bell MD PCGroup PAC ID 3971086158, 7 clinicians
AsanteGroup PAC ID 0547177321, 141 clinicians

Practice addresses (Care Compare)

2375 E Prater Way
Sparks, NV 89434-9641
Phone (775) 331-7000

2825 E Barnett Rd
Medford, OR 97504-8332
Phone (541) 789-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA228829ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Eds-I Homansky Practices of Nevada PC Physician Assistant Current Accepting new patients
Edwards Bell MD PC CurrentSince Jan 30, 2026 Accepting new patients
Eds-I Homansky Practices of Nevada PC Physician Assistant CurrentSince Jan 2, 2023 Accepting new patients
Penobscot Valley Hospital Past Accepting new patients
Penobscot Valley Hospital Past Accepting new patients

Locations

360 S Lola Ln
Pahrump, NV 89048
Phone (775) 751-7500

6500 Longley Ln
Reno, NV 89511
Phone (775) 331-7000

1511 Oppio Ranch Pkwy
Sparks, NV 89436
Phone (775) 567-5400

2375 E Prater Way
Sparks, NV 89434
Phone (775) 331-7000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5664/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-usa.unify.chbase.com/org/penob-eadbba22

Organizations & group practices 6

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 7

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": "1406246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778025600000",
    "number": "1144638859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 E BARNETT RD",
            "address_2": "MSS",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048332",
            "telephone_number": "541-789-4281",
            "fax_number": "541-789-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 MAPLE ST",
            "city": "ASHLAND",
            "state": "OR",
            "postal_code": "975201552",
            "telephone_number": "541-201-4000",
            "fax_number": "541-488-7437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUKIA",
        "first_name": "REVAZ",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-25",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA228829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashland, OR

Sources for this page

Verify at the official NPI Registry.