Ellie Raines Boardman

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

15074 SE Bevington Ave
Milwaukie, OR 97267

Phone

(503) 307-0159

NPI assigned

Jan 13, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Boardman Surgical LLC

  • Surgical Physician Assistant
  • Milwaukie, OR
  • NPI 1033700059

  Surgical Assistant

  NPD Authorized official
• Boardman Surgical LLC

  • Surgical Assistant
  • Oregon City, OR
  • NPI 1972192896
  NPD Authorized official

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1346839347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15074 SE BEVINGTON AVE",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "97267",
            "telephone_number": "503-307-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15074 SE BEVINGTON AVE",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "97267",
            "telephone_number": "503-307-0159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Division St",
            "address_purpose": "LOCATION",
            "city": "Oregon City",
            "state": "OR",
            "postal_code": "970451527",
            "country_code": "US",
            "telephone_number": "503-650-6762",
            "fax_number": "503-650-6851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOARDMAN",
        "first_name": "ELLIE",
        "middle_name": "RAINES",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": null,
            "license": "199221",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan M. Blatt, M.D.
• Natasha Diane Bledsoe, MA SLP
• Jaclyn Lee Bloom, COTA
• Blossom Midwifery LLC
• Boardman Surgical LLC
• Samantha Bobbitt
• Body Works Wellness Center LLC
• Jaylene Amber Boggs, CERTIFIED OCCUPATION
• Casey Frances Bohannon, CADC III, QMHP , MS
• Amie Boivin

• Surgical Physician Assistant in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Surgical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.