NPIMap

Individual provider Active NPI

Mary L Borgstadt, ARNP

  • Family Nurse Practitioner
  • Auburn, WA
National Provider Identifier
1407828569
Registry record updated May 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP30006913 Issued in WA
Practice address
735 12TH St SE
Auburn, WA 98002-6709
Phone
(253) 876-7990
NPI assigned
Feb 3, 2006
Last updated
May 6, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP30006913 WA Primary
Cardiovascular Disease Physician 207RC0000X RN00157592 WA

Addresses

Primary practice location

735 12TH St SE
Auburn, WA 98002-6709

Mailing address

735 12TH St SE
Auburn, WA 98002-6709
Phone (253) 876-7990

Other identifiers 3

IdentifierTypeStateIssuer
P0026399OtherWARAIL ROAD MEDICARE
7235BOOtherWAINDIVIDUAL BLUE SHIED
9645029MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20180403002724 SD Practitioner - Nurse Practitioner 6305885260 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN00157592WAMDCardiovascular Disease Physician
AP30006913WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Nov 23, 2020 Accepting new patients
Avera McKennan CurrentSince Nov 23, 2020 Accepting new patients
City of Sioux Falls CurrentSince Feb 21, 2018 Accepting new patients
City of Sioux Falls CurrentSince Feb 21, 2018 Accepting new patients
Avera McKennan Current Accepting new patients
Rural Health Care, Inc. CurrentSince Nov 23, 2020 Accepting new patients
Rural Health Care, Inc CurrentSince Nov 23, 2020 Accepting new patients
City of Sioux Falls Current Accepting new patients
Lake Tapps Family Medicine, PLLC Past Accepting new patients
Lakeside Family Physicians PLLC Past Accepting new patients

Locations

101 S Front St
Chamberlain, SD 57325
Phone (605) 234-6584

521 N Main Ave
Ste 100
Sioux Falls, SD 57104
Phone (605) 367-8029

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1293/brand/3/csg/42/fhir/r4

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462492800000",
    "number": "1407828569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 12TH ST SE",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980026709",
            "telephone_number": "253-876-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 12TH ST SE",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980026709",
            "telephone_number": "253-876-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORGSTADT",
        "first_name": "MARY",
        "middle_name": "L",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-03",
        "last_updated": "2016-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP30006913",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WA",
            "license": "RN00157592",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P0026399",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL BLUE SHIED",
            "identifier": "7235BO",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9645029",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Auburn, WA

Sources for this page

Verify at the official NPI Registry.