Active NPI
Stefanie Bouma, PA
- Physician Assistant
- Seattle, WA
National Provider Identifier
1154865525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA60889301
- Practice address
- 825 Eastlake Ave E
Seattle, WA 98109-4405 - Phone
- (206) 520-5000
- NPI assigned
- Dec 5, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA60889301 | WA | Primary |
Addresses
Primary practice location
825 Eastlake Ave E
Seattle, WA 98109-4405
Mailing address
PO Box 50095
Seattle, WA 98145-5095
Phone (206) 520-5700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154865525 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
3260 Hospital Dr
Juneau, AK 99801-7808
3268 Hospital Dr
Suite B
Juneau, AK 99801-7800
Phone (907) 796-8720
Hospital & facility affiliations
- Bartlett Regional Hospital
- Southeast Alaska Regional Health Consortium
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA60889301 | WA | MD | Physician Assistant |
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.
-
- Medical Specialty Clinic/Center
- Juneau, AK
- NPI 1477909067
Hospital & facility affiliations 36
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Juneau, AK
- NPI 1891849261
-
- Clinic/Center
- Tenakee Springs, AK
- NPI 1477721280
Hospital
-
- Nursing Facility/Intermediate Care Facility
- Juneau, AK
- NPI 1932312485
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634601600000",
"number": "1154865525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 50095",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981455095",
"telephone_number": "206-520-5700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 EASTLAKE AVE E",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981094405",
"telephone_number": "206-520-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUMA",
"first_name": "STEFANIE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-05",
"last_updated": "2021-10-19",
"certification_date": "2021-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA60889301",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1154865525",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.