Boulder Care Provider Group PA
NPI 1649838590 · Addiction Medicine (Family Medicine) Physician · Portland, OR
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Boulder Care Provider Group PA is a Addiction Medicine (Family Medicine) Physician organization in Portland, OR (NPI 1649838590).
Provider details
- NPI number
- 1649838590
- Entity type
- Organization
- Primary specialty
- Addiction Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Pia Shivdasani, Vp Operations, Authorized Agent(888) 288-4715
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Boulder Care
Registry dates
- Enumerated
- 2019-06-04
- Last updated
- 2024-06-26
- Certified
- 2024-06-26
Frequently asked questions
- What is Boulder Care Provider Group PA's NPI number?
- Boulder Care Provider Group PA's National Provider Identifier (NPI) is 1649838590, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Boulder Care Provider Group PA?
- Boulder Care Provider Group PA is classified in the NPPES registry as Addiction Medicine (Family Medicine) Physician (Allopathic & Osteopathic Physicians).
- Where is Boulder Care Provider Group PA located?
- Boulder Care Provider Group PA's practice location on file with NPPES is 111 Sw Naito Pkwy Ste 200, Portland, OR 97204-3512.
- What is Boulder Care Provider Group PA's phone number?
- The practice phone number listed in the NPPES registry for Boulder Care Provider Group PA is (888) 316-0451.
- Does Boulder Care Provider Group PA accept Medicare?
- Boulder Care Provider Group PA is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Boulder Care Provider Group PA?
- The authorized official listed on Boulder Care Provider Group PA's NPPES record is Pia Shivdasani, Vp Operations, Authorized Agent. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Boulder Care Provider Group PA's NPI active?
- Yes — Boulder Care Provider Group PA's NPI (1649838590) is active in the NPPES registry as of the last update on 2024-06-26.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.