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

Addison Broc Wooldridge, PA-C

Individual provider Physician Assistant · NPI 1407691835

Addison Broc Wooldridge, PA-C is a Physician Assistant in Boise, Idaho. Qualified in 2023, 3 years ago. Practices with Direct Orthopedic Care LLC, a 31-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
3
Licensed in
ID
In the registry since
2024
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

9475 W Tillamook Dr # A
Boise, ID 83709-6173
Phone: (661) 205-1177
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2810 (ID)

Record details

NPI number1407691835
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedJune 27, 2024
Last updated in NPPESJune 27, 2024
Certification dateJune 27, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Direct Orthopedic Care Llc — 31 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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