NPIMap

Individual provider Active NPI

Andrew J Boulet, MD

  • Cardiovascular Disease Physician
  • Spokane, WA
National Provider Identifier
1336195064
Registry record updated Jan 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD28359 Issued in WA
Practice address
62 W 7TH Ave Ste 320
Spokane, WA 99204-2321
Phone
(509) 455-8820
Fax
(509) 838-4978
NPI assigned
May 25, 2006
Last updated
Jan 16, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD28359 WA Primary

Addresses

Primary practice location

62 W 7TH Ave Ste 320
Spokane, WA 99204-2321

Mailing address

PO Box 31001-4114
Pasadena, CA 91110-0001
Phone (866) 747-2455

Other practice location 1

62 W 7th Ave Ste 450
Spokane, WA 99204-2321
Phone (509) 455-8820

Other identifiers 1

IdentifierTypeStateIssuer
003212600MedicaidID

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aboulet220687@wm.providencedirect.org Direct

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
I20040510001453 WA Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 5597754929 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
University of Texas Southwestern Medical School at Dallas, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services WashingtonGroup PAC ID 8729258256, 53 clinicians

Practice addresses (Care Compare)

62 W 7TH Ave
Suite 450
Spokane, WA 99204-2321
Phone (509) 455-8820

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD28359WAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-State Memorial Hospital CurrentSince Jan 1, 2026 Accepting new patients
Northwest Cardiac and Vascular Imaging, LLC PastSince Nov 1, 2004 Accepting new patients

Locations

1221 Highland Ave
Clarkston, WA 99403
Phone (509) 751-0312

Interoperability endpoints

  • Direct secure messaging: aboulet220687@wm.providencedirect.org

Organizations & group practices 3

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 6

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768521600000",
    "number": "1336195064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911100001",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 W 7TH AVE STE 320",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042321",
            "telephone_number": "509-455-8820",
            "fax_number": "509-838-4978"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "62 W 7th Ave Ste 450",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992042321",
            "country_code": "US",
            "telephone_number": "509-455-8820",
            "fax_number": "509-838-4978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOULET",
        "first_name": "ANDREW",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WA",
            "license": "MD28359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003212600",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aboulet220687@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "62 W 7th Ave Ste 450",
            "city": "Spokane",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992042321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.