Ellen Marie Boersma, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

18609 Issued in CA

Practice address

5150 Hill Rd E
#F
Lakeport, CA 95453-5101

Phone

(707) 262-3060

NPI assigned

Oct 16, 2008

Last updated

Oct 16, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sutter Bay HospitalsGroup PAC ID 3476506528, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Lakeside Hospital Hospital, Lakeport, CA, CCN 051329
• Adventist Health Clearlake Hospital, Clearlake, CA, CCN 051317

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eboersma194541@hisp.ehr.sutterhealth.org
• Direct secure messaging: ellen.boersma@stjoe.direct.varian.com

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.

• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1740413798
  Medicare reassignment Care Compare group NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment
• Providence Medical Foundation

  • Obstetrics & Gynecology Physician
  • Napa, CA
  • NPI 1205131950
  NPD
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• Sutter Bay Hospitals

  dba Alta Bates Summit Medical Center - Summit Campus

  • Rehabilitation Hospital Unit
  • Oakland, CA
  • NPI 1194171371
  NPD
• Sutter Bay Hospitals

  • Clinic/Center
  • Lakeport, CA
  • NPI 1356779797
  NPD
• Redwood Regional Medical Group Inc

  • Hematology & Oncology Physician
  • Santa Rosa, CA
  • NPI 1275556607

  Nurse Practitioner

  NPD (past)
• Redwood Regional Medical Group, Inc.

  dba Redwood Regional Oncology Center

  • Clinical Medical Laboratory
  • Santa Rosa, CA
  • NPI 1588743264
  NPD (past)

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

• Adventist Health Clearlake Hospital Inc.

  dba Adventist Health Clear Lake

  • Critical Access Hospital
  • Clearlake, CA
  • NPI 1124018031
  Care Compare affiliation
• Sutter Bay Hospitals

  • Critical Access Hospital
  • Lakeport, CA
  • NPI 1952634008
  Care Compare affiliation

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224115200000",
    "number": "1265684633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 HILL RD E",
            "address_2": "#F",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535101",
            "telephone_number": "707-262-3060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 HILL RD E",
            "address_2": "#F",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535101",
            "telephone_number": "707-262-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOERSMA",
        "first_name": "ELLEN",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-16",
        "last_updated": "2008-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "18609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evan John Bettey, COTA/L
• Kimberly Bigelman, LCSW
• Elvina Angelica Bill
• Donovan C Bland, MD
• Martyna Joanna Blissky
• Ronald J Botelho, M.D.
• Emmalena Ann Boyd, OD
• Kathleen Louise Bradley, P. T.
• Stephen Peter Bradley, MD
• David L. Browning, O.D.

• Nurse Practitioner in Lakeport, CA
• Providers in Lakeport, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; 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.

Verify at the official NPI Registry.