Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Boulder Care Provider Group PA

Organization Addiction Medicine (Family Medicine) Physician · NPI 1649838590

Boulder Care Provider Group PA is an Addiction Medicine (Family Medicine) Physician in Portland, Oregon. Registered with an NPI since 2019.

In the registry since
2019
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

111 SW Naito Pkwy Ste 200
Portland, OR 97204-3512
Phone: (888) 316-0451
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction Medicine (Family Medicine) Physician (primary) Taxonomy 207QA0401X

Record details

NPI number1649838590
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Pia Shivdasani — Vp Operations, Authorized Agent · (888) 288-4715
Other names Boulder Care
NPI enumeratedJune 4, 2019
Last updated in NPPESJune 26, 2024
Certification dateJune 26, 2024
Mailing address111 Sw Naito Pkwy Ste 200, Portland, OR 97204-3512

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