Active NPI
Rob S Boudewijn, PA
- Physician Assistant
- Augusta, ME
National Provider Identifier
1861453680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA439
- Practice address
- 6 E Chestnut St
Augusta, ME 04330-5717 - Phone
- (207) 626-1303
- NPI assigned
- Mar 31, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA439 | ME | Primary |
Addresses
Primary practice location
6 E Chestnut St
Augusta, ME 04330-5717
Mailing address
6 E Chestnut St
Augusta, ME 04330-5717
Phone (207) 626-1303
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 154420000 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA439 | ME | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214956800000",
"number": "1861453680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 E CHESTNUT ST",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043305717",
"telephone_number": "207-626-1303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 E CHESTNUT ST",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043305717",
"telephone_number": "207-626-1303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDEWIJN",
"first_name": "ROB",
"middle_name": "S",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2008-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ME",
"license": "PA439",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "154420000",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.