Active NPI
Carl Jay Bodenstein, MD
- Neonatal-Perinatal Medicine Physician
- Spokane, WA
National Provider Identifier
1811960156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal-Perinatal Medicine Physician
- License
- MD00020651
- Practice address
- 105 W 8TH Ave
Ste 336C
Spokane, WA 99204-2302 - Phone
- (509) 455-8855
- Fax
- (509) 455-8383
- NPI assigned
- Feb 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal-Perinatal Medicine Physician | 2080N0001X | MD00020651 | WA | Primary |
Addresses
Primary practice location
105 W 8TH Ave
Ste 336C
Spokane, WA 99204-2302
Mailing address
105 W 8TH Ave
Ste 336C
Spokane, WA 99204-2302
Phone (509) 455-8855
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10004603 | Other | WA | REGENCE BLUE S. OF IDAHO |
| 911922781 | Other | WA | PHCO |
| 911922781 | Other | WA | CIGNA |
| BO6528 | Other | WA | ASURIS NW HEALTH |
| 911922781 | Other | WA | PREMERA |
| 911922781 | Medicaid | WA | |
| 8458507 | Medicaid | WA | |
| KA345 | Other | WA | BLUE CROSS OF IDAHO |
| 000038801 | Medicaid | ID | |
| 205997 | Medicaid | OR | |
| 0000108137 | Medicaid | MT | |
| 5404342 | Other | WA | AETNA |
| 911922781 | Other | WA | UNITED HEALTH CARE |
| 911922781 | Other | WA | GROUP HEALTH NW |
Medicare participation
Medicare enrollment files- 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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120103000770 | WA | Order and Referring Only - Pediatric Medicine | 1557537164 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neonatology Associates Spokane PS | Neonatal-Perinatal Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Neonatal-Perinatal Medicine Physician
- Spokane, WA
- NPI 1831263938
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261353600000",
"number": "1811960156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 W 8TH AVE",
"address_2": "STE 336C",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042302",
"telephone_number": "509-455-8855",
"fax_number": "509-455-8383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 W 8TH AVE",
"address_2": "STE 336C",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042302",
"telephone_number": "509-455-8855",
"fax_number": "509-455-8383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODENSTEIN",
"first_name": "CARL",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-08",
"last_updated": "2009-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "WA",
"license": "MD00020651",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE S. OF IDAHO",
"identifier": "10004603",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCO",
"identifier": "911922781",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "911922781",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASURIS NW HEALTH",
"identifier": "BO6528",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA",
"identifier": "911922781",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "911922781",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8458507",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "KA345",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000038801",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "205997",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000108137",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5404342",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "911922781",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH NW",
"identifier": "911922781",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; 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.