ANDREW DAVID BODMER (NPI# 1083860548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083860548 |
| Entity Type | Individual |
| Full Name | ANDREW DAVID BODMER |
| Credential | PA-C |
| Practice Address |
18040 Sw Lower Boones Ferry Rd Suite 100 Tigard OR 97224-7259 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032160700 |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2020-10-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA161375 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
T-4239 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500655799 | 05 |
| Street Address |
18040 SW LOWER BOONES FERRY RD SUITE 100 |
| City | TIGARD |
| State | OR |
| Zip Code | 97224-7259 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952384430 | Pamela A. Devisser | Nurse Practitioner | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7258 | 2005-11-29 |
| 1689211740 | Gabrielle Johnson | Specialist/Technologist | 18040 Sw Lower Boones Ferry Rd, Tigard, OR 97224-7258 | 2019-12-06 |
| 1326588708 | Susan Kathleen Glinka | Psychologist | 18040 Sw Lower Boones Ferry Rd, Suite 304, Tigard, OR 97224-7258 | 2017-03-03 |
| 1720402472 | Providence Health & Services - Oregon | Internal Medicine | 18040 Sw Lower Boones Ferry Rd, Suite 204, Tigard, OR 97224-7259 | 2014-02-14 |
| 1689097131 | Providence Health & Services - Oregon | Internal Medicine | 18040 Sw Lower Boones Ferry Rd, Suite 204, Tigard, OR 97224-7259 | 2014-02-03 |
| 1790113405 | Providence Health & Services - Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7259 | 2013-10-16 |
| 1669726345 | Deborah Ann Jones | Physical Therapist | 18040 Sw Lower Boones Ferry Rd, Tigard, OR 97224-7258 | 2012-11-02 |
| 1568749539 | Heather Leann Adair | Physician Assistant | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7258 | 2011-11-04 |
| 1568756591 | Michael D Goodwin | Family Medicine | 18040 Sw Lower Boones Ferry Rd, Ste 100, Tigard, OR 97224-7258 | 2011-06-07 |
| 1245549724 | Providence Health & Services Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 207, Tigard, OR 97224-7259 | 2010-09-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154973139 | Katherine Raineri | Psychologist | 7213 Sw Hazel Fern Rd, Tigard, OR 97224 | 2019-07-10 |
| 1871064618 | Stacey A Wenzel | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Rd.,suite 201, Tigard, OR 97224 | 2018-12-05 |
| 1376010090 | Meredith Rae Brezinski | Physical Therapist | 18019 Sw Boones Ferry Road, Tigard, OR 97224 | 2018-10-31 |
| 1649759358 | Viktoriya A Chiliy | Behavior Technician | 15290 Sw Royalty Parkway, Tigard, OR 97224 | 2018-08-13 |
| 1609384866 | Rachel E King | Physical Therapist | 18040 Sw Lower Boones Ferry Rd Ste 200, Tigard, OR 97224 | 2018-01-22 |
| 1689190134 | Isabelle Cooper Klee Caballero | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Road Suite 201, Tigard, OR 97224 | 2017-08-16 |
| 1427573146 | Breanna M Sandefur | Behavior Technician | 15290 Sw Royalty Pkwy, Tigard, OR 97224 | 2017-08-03 |
| 1083141196 | Krista Espenship | Registered Nurse | 8032 Sw Ashford St, Tigard, OR 97224 | 2017-05-19 |
| 1275067928 | Emily Elizabeth Myers | Behavioral Analyst | 15290 Royalty Parkway, Tigard, OR 97224 | 2017-04-19 |
| 1235684937 | Melanie Salvador | Nurse Practitioner | 15352 Sw Oakmont Pl, Tigard, OR 97224 | 2016-08-23 |
| Find all providers in zip 97224 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891268041 | Linh Hai Nguyen | Physician Assistant | 12230 Sw 128th Ave, Tigard, OR 97223-1865 | 2019-01-09 |
| 1043717390 | Rayna Donnelly | Physician Assistant | 9735 Sw Shady Ln Ste 102, Tigard, OR 97223 | 2018-04-11 |
| 1689191827 | Hannah Raines Jones | Physician Assistant | 16083 Sw Upper Boones Ferry Rd Ste 320, Tigard, OR 97224-7736 | 2017-08-28 |
| 1679913677 | Adam Sherman | Physician Assistant | 9855 Sw Peppertree Ln, Tigard, OR 97224-4787 | 2013-07-05 |
| 1831269265 | Andrew Tistadt | Physician Assistant | 18040 Sw Lower Boones Ferry Rd Ste 304, Tigard, OR 97224-7258 | 2006-11-09 |
| 1295818383 | Jennifer K. Van Atta | Physician Assistant | 15755 Sw Sequoia Pkwy Ste 200, Tigard, OR 97224-7166 | 2006-10-23 |
| 1114533072 | Geneva Ann Green | Physician Assistant | 16083 Sw Upper Boones Ferry Rd Ste 130, Tigard, OR 97224-7737 | 2020-09-16 |
| 1801451612 | Emily Ortiz | Physician Assistant | 15755 Sw Sequoia Pkwy Ste 200, Tigard, OR 97224-7166 | 2019-05-07 |
| 1306303466 | Elizabeth Marie Miller | Physician Assistant | 7421 Sw Bridgeport Rd Ste 215, Tigard, OR 97224-7707 | 2019-02-25 |
| 1699241125 | Kayla Moody | Physician Assistant | 15755 Sw Sequoia Pkwy, Tigard, OR 97224-7166 | 2018-10-23 |
| Find all providers in TIGARD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.