Gary L Boog, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA60037894 Issued in WA

Practice address

915 Anderson Dr
Aberdeen, WA 98520-1006

Phone

(360) 532-8830

NPI assigned

Nov 17, 2006

Last updated

Oct 17, 2016By the provider in NPPES

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

Other names 1

• Gary L Boog Professional name

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grays Harbor Community Hospital

  • General Acute Care Hospital
  • Aberdeen, WA
  • NPI 1154378859
  Medicare reassignment
• Grays Harbor Community Hospital

  dba Grays Harbor Radiology

  • General Acute Care Hospital
  • Aberdeen, WA
  • NPI 1144676487
  NPD
• Grays Harbor Community Hospital

  dba GHCH Westport Clinic

  • Clinic/Center
  • Westport, WA
  • NPI 1497510333
  NPD
• Coastal Internal Medicine, PLLC

  • Physician Assistant
  • Aberdeen, WA
  • NPI 1740528884
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476662400000",
    "number": "1710051255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 ANDERSON DR",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985201006",
            "telephone_number": "360-532-8830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 ANDERSON DR",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985201006",
            "telephone_number": "360-532-8830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOG",
        "first_name": "GARY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2016-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60037894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GARY",
            "last_name": "BOOG",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Margaret Blake, CF-SLP
• Tiffany Hazel Mencias Blankenship, MD
• Alice Marie Bledsoe, M.ED
• Tori Ann Blume, DOULA
• Gregory G Bogdanovich, O.D.
• Kristin Marijean Boogaard, BS, MSW CANDIDATE
• Stephanie Leigh Boone, DPT
• Cheryl Ann Boyer I
• Robert E Boyle Jr., PHARMD
• Veronica Xena Rose Bradley

• Medical Physician Assistant in Aberdeen, WA
• Providers in Aberdeen, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.