Tina M Bousman, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085-002077 Issued in IL

Practice address

4400 W 95TH St
Suite 306
Oak Lawn, IL 60453-2654

Phone

(708) 346-5562

Fax

(708) 346-2059

NPI assigned

Sep 21, 2005

Last updated

May 17, 2010By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: tbousman278426@direct.myadvocateaurora.org

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274054400000",
    "number": "1598751901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 W 95TH ST",
            "address_2": "SUITE 306",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532654",
            "telephone_number": "708-346-5562",
            "fax_number": "708-346-2059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 W 95TH ST",
            "address_2": "SUITE 306",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532654",
            "telephone_number": "708-346-5562",
            "fax_number": "708-346-2059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSMAN",
        "first_name": "TINA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2010-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-002077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Botti Chiropractic & Wellness Inc.
• Valentino R Botti, D.C.
• John Bowman, MD
• Shandrea Boyd, PT, DPT
• Robert Boyle
• Sarah B Bradley, DPT
• Tiara Bradley, MD

• Medical Physician Assistant in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; 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.