Jefferson L Boulet, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10003567 Issued in WA

Practice address

305 N River Ave
Buckley, WA 98321-8978

Phone

(360) 829-0625

Fax

(360) 829-9860

NPI assigned

Sep 6, 2005

Last updated

Mar 7, 2023By 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 identifiers 1

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

Specialty

Physician Assistant

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

White River Family Care LLCGroup PAC ID 1254323447, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
• St Elizabeth Hospital Hospital, Enumclaw, WA, CCN 501335
• Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• White River Family Care LLC

  • Family Medicine Physician
  • Buckley, WA
  • NPI 1649394800
  Medicare reassignment Care Compare group

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

• Commonspirit Washington

  dba St Joseph Lab PAC LAB

  • Clinical Medical Laboratory
  • Tacoma, WA
  • NPI 1659585370

  Hospital

  Care Compare affiliation
• Commonspirit Washington

  dba St Joseph Medical Center

  • General Acute Care Hospital
  • Tacoma, WA
  • NPI 1952309098
  Care Compare affiliation
• Enumclaw Regional Hospital Association

  dba St. Elizabeth Hospital

  • Critical Access Hospital
  • Enumclaw, WA
  • NPI 1073674040
  Care Compare affiliation
• Franciscan Health System

  dba St Joseph Medical Center

  • General Acute Care Hospital
  • Tacoma, WA
  • NPI 1124291117
  Care Compare affiliation
• Multicare Health System

  dba Tacoma General Allenmore

  • General Acute Care Hospital
  • Tacoma, WA
  • NPI 1366556227
  Care Compare affiliation

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1740274745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1268",
            "city": "BUCKLEY",
            "state": "WA",
            "postal_code": "983211268",
            "telephone_number": "360-829-0625",
            "fax_number": "360-829-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 N RIVER AVE",
            "city": "BUCKLEY",
            "state": "WA",
            "postal_code": "983218978",
            "telephone_number": "360-829-0625",
            "fax_number": "360-829-9860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULET",
        "first_name": "JEFFERSON",
        "middle_name": "L",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8542300",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Bolesky Intention Inc (Soma Institute of Neuromuscular Integration)
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• Angela Christine Bushmaker, LAT, ATC
• Heather S Campbell, RN
• Stacy Lynn Cargill, LPN
• Leah K Carthum

• Medical Physician Assistant in Buckley, WA
• Providers in Buckley, 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 Mar 7, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.