Boulder Care Provider Group PA
NPI 1649838590ActiveOrganization· Family Medicine, Addiction Medicine· Portland, OR
Family Medicine, Addiction Medicine in Portland, Oregon, registered in NPPES in June 2019. The authorized official on file is Pia Shivdasani, Vp Operations, Authorized Agent. Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - clinic/group practice.
Overview
| NPI | 1649838590 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 4, 2019 |
| Last updated in NPPES | Jun 26, 2024 |
| Certified by provider | Jun 26, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine, Addiction Medicine Primary | 207QA0401X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (CO); Part B Supplier - Clinic/Group Practice (ID); Part B Supplier - Clinic/Group Practice (NC); Part B Supplier - Clinic/Group Practice (OH); Part B Supplier - Clinic/Group Practice (OR); Part B Supplier - Clinic/Group Practice (PA); Part B Supplier - Clinic/Group Practice (WA) |
|---|
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