Philip Goldman Boekelheide, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

56300 Issued in CA

Practice address

1700 E Cesar E Chavez Ave Ste 2500
Los Angeles, CA 90033-2434

Phone

(323) 268-6731

NPI assigned

Nov 21, 2018

Last updated

May 24, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: pboekelheide@delreysinus.emadirect.md

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

{
    "created_epoch": "1542758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1962971788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4640 ADMIRALTY WAY",
            "address_2": "STE 718",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926634",
            "telephone_number": "310-823-4444",
            "fax_number": "310-363-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E CESAR E CHAVEZ AVE STE 2500",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332434",
            "telephone_number": "323-268-6731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEKELHEIDE",
        "first_name": "PHILIP",
        "middle_name": "GOLDMAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-21",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "56300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; 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.