Individual provider Active NPI

Kirsten Boland, PA-C

  • Physician Assistant
  • Bend, OR
National Provider Identifier
1710531827
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA205597 Issued in OR
Practice address
1501 NE Medical Center Dr
Bend, OR 97701-6051
Phone
(541) 382-4900
NPI assigned
Jul 26, 2019
Last updated
Jan 4, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA205597 OR Primary
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

1501 NE Medical Center Dr
Bend, OR 97701-6051

Mailing address

1501 NE Medical Center Dr
Bend, OR 97701-6051
Phone (541) 382-4900

Other identifiers 1

IdentifierTypeStateIssuer
500795490MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kboland18392@directmsg.bmctotalcare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20210720003584 OR Practitioner - Physician Assistant 5799016051 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates PCGroup PAC ID 2567364847, 25 clinicians

Practice addresses (Care Compare)

1255 Hilyard St
Eugene, OR 97401-3718
Phone (541) 686-7300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA205597ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Associates PC CurrentSince Apr 29, 2024 Accepting new patients
Bend Memorial Clinic PC CurrentSince Aug 1, 2021 Accepting new patients

Locations

1501 NE Medical Center Dr
Bend, OR 97701
Phone (541) 317-4354

1200 Hilyard St
Ste 330
Eugene, OR 97401
Phone (541) 302-7771

1255 Hilyard St
Eugene, OR 97401
Phone (503) 686-7300

Interoperability endpoints

  • Direct secure messaging: kboland18392@directmsg.bmctotalcare.com

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1710531827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 NE MEDICAL CENTER DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016051",
            "telephone_number": "541-382-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 NE MEDICAL CENTER DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016051",
            "telephone_number": "541-382-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAND",
        "first_name": "KIRSTEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-26",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA205597",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500795490",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kboland18392@directmsg.bmctotalcare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1501 NE Medical Center Dr",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977016051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.