David Ryan Bolthouse, M.D.
Individual provider Active NPI Family Medicine Physician · Poulsbo, WA
NPI 1811275563 · NPPES record last updated May 18, 2021
Key facts
- NPI
- 1811275563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD60868114 (WA)
- Practice address
- 19379 7TH Ave NE
Poulsbo, WA 98370-7504 - Phone
- (360) 394-1000
- NPI assigned
- Jul 29, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Wayne State University School of Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Kaiser Foundation Health Plan of Washington
Practice addresses (Care Compare)
10452 Silverdale Way NW
Silverdale, WA 98383-9411
Phone (360) 307-7300
1400 Pottery Ave
Port Orchard, WA 98366-3711
Phone (360) 895-5000
9505 S Steele St
Tacoma, WA 98444-1858
Phone (253) 597-6800
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190123002656 | WA | Practitioner - Family Practice | 3971840380 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD60868114 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of Washington | Current | Accepting new patients | |
| Kaiser Foundation Health Plan of Washington | Family Medicine | Current |
Accepting new patients |
| Kaiser Foundation Health Plan of Washington | Current |
Accepting new patients |
Locations
19379 7th Ave NE
Poulsbo, WA 98370
Phone (360) 394-1000
200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530
9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800
Interoperability endpoints
- dbolthouse197350@ghc.direct-ci.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD60868114 | WA | Yes |
Addresses
Primary practice location
19379 7TH Ave NE
Poulsbo, WA 98370-7504
Mailing address
19379 7TH Ave NE
Poulsbo, WA 98370-7504
Phone (360) 394-1000
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync | Health Information Exchange (HIE) |
Other providers in Poulsbo, WA
- Elizabeth Randell Blackburn
- Dale Bliss
- Kristin Switz Bloink
- Nina Bockholdt
- Kyle M Bogusz
- Vilma Boon
- Erica Aragon Bottai
- Boudreaux Optics, P.L.L.C
- Paul Boudreaux
- John Frank Boulukos
All providers in Poulsbo, WA · Family Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.