NPIMap

Individual provider Active NPI

Bose Amosun

  • Physician Assistant
  • Puyallup, WA
National Provider Identifier
1962283622
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.PA.61492017 Issued in WA
Practice address
611 31St Ave SW
Puyallup, WA 98373-3723
Phone
(253) 848-5951
NPI assigned
Oct 9, 2023
Last updated
Dec 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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 PA.PA.61492017 WA Primary

Addresses

Primary practice location

611 31St Ave SW
Puyallup, WA 98373-3723

Mailing address

2904 4TH Ave NE
Puyallup, WA 98372-7053
Phone (253) 848-5951

Other practice location 1

21600 Highway 99 Ste 260
Edmonds, WA 98026-8049
Phone (425) 774-2650 ext. 7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231116002377 WA Practitioner - Physician Assistant 8224485933 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13020 Meridian Ave S
Everett, WA 98208-6468
Phone (425) 977-4620

21600 Hwy 99
Suite 260
Edmonds, WA 98026-8049
Phone (425) 774-2650

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.PA.61492017WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Puget Sound Gastroenterology, PLLC CurrentSince Feb 3, 2025 Accepting new patients
Sound Family Senior Clinic PLLC CurrentSince Oct 15, 2023 Accepting new patients
Puget Sound Gastroenterology, PLLC CurrentSince Feb 3, 2025 Accepting new patients
Kaiser Foundation Health Plan of Washington PastSince Oct 15, 2023 Accepting new patients

Locations

21600 Highway 99
Ste 260
Edmonds, WA 98026
Phone (425) 774-2650

13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700

2904 4th Ave NE
Puyallup, WA 98372
Phone (253) 848-4700

Interoperability endpoints

  • Direct secure messaging: bose.amosun@gastrohealth.eclinicaldirectplus.com
  • FHIR API: https://7e6d65ac-543a-4d66-acb8-36b51c8c951c.gastro.prod.fhir.ema-api.com/fhir/r4/
  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1962283622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 4TH AVE NE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983727053",
            "telephone_number": "253-848-5951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 31ST AVE SW",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733723",
            "telephone_number": "253-848-5951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21600 Highway 99 Ste 260",
            "address_purpose": "LOCATION",
            "city": "Edmonds",
            "state": "WA",
            "postal_code": "980268049",
            "country_code": "US",
            "telephone_number": "425-774-2650 x7246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMOSUN",
        "first_name": "BOSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-09",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.PA.61492017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.