Addison Broc Wooldridge, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-2810 Issued in ID

Practice address

9475 W Tillamook Dr # a
Boise, ID 83709-6173

Phone

(661) 205-1177

NPI assigned

Jun 27, 2024

Sex

Male

Sole proprietor

Yes

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 ID

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

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Direct Orthopedic Care LLCGroup PAC ID 2163648155, 32 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Treasure Valley Hospital Hospital, Boise, ID, CCN 130063

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Direct Orthopedic Care LLC

  • Orthopaedic Surgery Physician
  • Boise, ID
  • NPI 1356769434
  Medicare reassignment Care Compare group NPD

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

• Treasure Valley Hospital Limited Partnership

  • Special Hospital
  • Boise, ID
  • NPI 1720040132
  Care Compare affiliation

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1407691835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9475 W TILLAMOOK DR # A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837096173",
            "telephone_number": "661-205-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9475 W TILLAMOOK DR # A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837096173",
            "telephone_number": "661-205-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOLDRIDGE",
        "first_name": "ADDISON",
        "middle_name": "BROC",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malinda Woods, LCSW
• Nick L Woods, MSPT
• Seneca J Woods, DPT,MOT
• Dennis J Woody, PH D
• Sonya Rose Wool, LAC
• Kyla Megan Wooley, PA
• Reuben Lika Wooley
• Scott Woolf, M.D.
• Tanner Woolf, PA
• Paige M Wooten, LMSW

• Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; 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.