Boden Bradley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

56390 Issued in CA

Practice address

3005 Douglas Blvd Ste 105
Roseville, CA 95661-3885

Phone

(916) 742-7718

Fax

(510) 350-9190

NPI assigned

Aug 12, 2016

Sex

Male

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bbradley445680@hisp.ehr.sutterhealth.org

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.

• Tri-City Express Care, PLLC

  dba FastMed Urgent Care

  • Family Medicine Physician
  • Mesa, AZ
  • NPI 1649554940
  NPD
• Sutter West Bay Medical Foundation

  dba Sutter Pacific Medical Foundation

  • Family Medicine Physician
  • Santa Rosa, CA
  • NPI 1346575073

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1699229112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3005 DOUGLAS BLVD STE 105",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613885",
            "telephone_number": "916-742-7718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 DOUGLAS BLVD STE 105",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613885",
            "telephone_number": "916-742-7718",
            "fax_number": "510-350-9190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2920 N Green Valley Pkwy Ste 814",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890140409",
            "country_code": "US",
            "telephone_number": "702-832-3600",
            "fax_number": "702-832-5733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "BODEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-12",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "56390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dominique Boynton
• Madelyn Brabon
• Gwyneth Paige Brace
• Oliver Tiamzon Bracero
• Christin Hopp Brackett, M.S., CCC-SLP
• Eric Bradley
• Jennifer Carvalho Bradley, RN, PHN
• Nicole Marie Bradley, DVM
• Rena Lucille Bradley
• Brittany Bradshaw, FNP

• Physician Assistant in Roseville, CA
• Providers in Roseville, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.