Individual provider Active NPI

William M. Bomberger, PA-C

  • Medical Physician Assistant
  • Spokane, WA
National Provider Identifier
1639194079
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA10004622 Issued in WA
Practice address
1001 W 2ND Ave
Spokane, WA 99201-4503
Phone
(509) 835-1205
Fax
(509) 835-1208
NPI assigned
Jul 13, 2006
Last updated
May 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-1486 ID
Medical Physician Assistant 363AM0700X PA10004622 WA Primary

Addresses

Primary practice location

1001 W 2ND Ave
Spokane, WA 99201-4503

Mailing address

611 N Iron Bridge Way Ste 300
Spokane, WA 99202-4932
Phone (509) 444-8888

Other identifiers 1

IdentifierTypeStateIssuer
8427098MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20040504000940 WA Practitioner - Physician Assistant 5597753954 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1001 W 2ND Ave
Spokane, WA 99201-4503
Phone (509) 835-1206

3919 N Maple St
Spokane, WA 99205-1349
Phone (509) 444-8888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-1486IDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Association of Spokane CurrentSince Mar 5, 2007 Accepting new patients
Community Health Association of Spokane CurrentSince Mar 5, 2007 Accepting new patients
Puget Sound Family Physicians PastSince Nov 1, 2009 Accepting new patients
Community Health Association of Spokane Past Accepting new patients
King County Public Hospital District No. 2 Past Accepting new patients

Locations

803 S Main St
Ste 120
Moscow, ID 83843
Phone (208) 848-8300

1720 2nd St
Cheney, WA 99004
Phone (207) 865-8002

1001 W 2nd Ave
Spokane, WA 99201
Phone (509) 835-1205

3919 N Maple St
Spokane, WA 99205
Phone (509) 326-6900

5620 S Regal St
Ste 11
Spokane, WA 99223
Phone (509) 340-1590

5921 N Market St
Spokane, WA 99208
Phone (509) 487-1604

611 N Iron Bridge Way
Ste 300
Spokane, WA 99202

914 W Carlisle Ave
Spokane, WA 99205
Phone (509) 325-0393

1502 N Vercler Rd
Spokane Valley, WA 99216
Phone (509) 444-8204

15812 E Indiana Ave
Ste 101
Spokane Valley, WA 99216

Interoperability endpoints

  • Direct secure messaging: william.bomberger.1@11411.direct.athenahealth.com

Organizations & group practices 5

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1639194079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY STE 300",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W 2ND AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992014503",
            "telephone_number": "509-835-1205",
            "fax_number": "509-835-1208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMBERGER",
        "first_name": "WILLIAM",
        "middle_name": "M.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-1486",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8427098",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.