Kendall Disa Boges, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC011466 Issued in GA

Practice address

1600 Ellis St
Brunswick, GA 31520-6737

Phone

(912) 289-1626

Fax

(912) 289-2414

NPI assigned

Oct 20, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kendall Disa Benton Professional name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kendall.benton@cchs.gadirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coastal Community Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Brunswick, GA
  • NPI 1609298751
  Medicare reassignment NPD
• Coastal Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brunswick, GA
  • NPI 1063282937
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1013634179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 DREW CIR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315251049",
            "telephone_number": "912-580-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 ELLIS ST",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315206737",
            "telephone_number": "912-289-1626",
            "fax_number": "912-289-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGES",
        "first_name": "KENDALL",
        "middle_name": "DISA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-20",
        "last_updated": "2022-10-20",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC011466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENDALL",
            "last_name": "BENTON",
            "middle_name": "DISA",
            "credential": "LPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tracie Bock, RD, LD
• David Thomas Boczar, D.C.
• Jennifer Leever Boczar, D.C.
• Brett A Bodamer, D.P.M.
• Marshall Boden
• Bettye Boggs-Costic, LPN
• Parameshwara Rao Bolla, MD
• Nicole Grant Bonds
• Matthew R Boothby
• Charity Christine Boree, MSN, APRN, FNP-C

• Professional Counselor in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.