Patricia A Boudet, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-000668 Issued in IL

Practice address

404 S Lewis LN
Carbondale, IL 62901-3547

Phone

(618) 519-9200

NPI assigned

Jun 2, 2006

Sex

Female

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Sterling Emergency Physicians of Illinois, S.C

  • Emergency Medicine Physician
  • Mount Vernon, IL
  • NPI 1295975837

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1841237120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 577",
            "address_2": "109 CALIFORNIA STREET",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629180577",
            "telephone_number": "618-985-8221",
            "fax_number": "618-985-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 S LEWIS LN",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013547",
            "telephone_number": "618-519-9200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 S Lewis Ln",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629013547",
            "country_code": "US",
            "telephone_number": "618-519-9900",
            "fax_number": "618-529-1384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUDET",
        "first_name": "PATRICIA",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-000668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370966854024",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PA MEDICAL LICENSE",
            "identifier": "085-000668",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Bordieri, PH.D
• Sarah Paige Born
• Julia Bost
• Bianca Bottiaux, PA
• Nichole Boudet, NP
• Elizabeth A Bowen, RN, ACCNS-AG
• Amanda J Bowers, FNP
• Annamaria Boyce, CRNA
• Brad McMillin, Inc
• Austin Bradley, FNP-C

• Physician Assistant in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.