Individual provider Active NPI

Laura Bouwsma

  • Physician Assistant
  • Santa Cruz, CA
National Provider Identifier
1801492442
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
59298 Issued in CA
Practice address
250 Locust St
Santa Cruz, CA 95060-3813
Phone
(831) 427-3500
NPI assigned
Dec 9, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 59298 CA Primary

Addresses

Primary practice location

250 Locust St
Santa Cruz, CA 95060-3813

Mailing address

PO Box 542
Santa Cruz, CA 95061-0542
Phone (831) 427-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20230504000682 CA Practitioner - Physician Assistant 1850756446 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
59298CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Cruz Community Health Centers CurrentSince Jun 7, 2021 Accepting new patients
Santa Cruz Community Health Centers Physician Assistant Past Accepting new patients

Locations

250 Locust St
Santa Cruz, CA 95060
Phone (831) 427-3582

Interoperability endpoints

  • Direct secure messaging: lbouwsma698502@direct.ochin.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1801492442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 542",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950610542",
            "telephone_number": "831-427-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 LOCUST ST",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950603813",
            "telephone_number": "831-427-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUWSMA",
        "first_name": "LAURA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-09",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "59298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.