Individual provider Active NPI

Alison Lynn Boden, PA-C

  • Physician Assistant
  • Orange Park, FL
National Provider Identifier
1053881995
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9111742 Issued in FL
Practice address
2055 Professional Center Dr
Orange Park, FL 32073-4461
Phone
(904) 276-4500
NPI assigned
Dec 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9111742 FL Primary

Addresses

Primary practice location

2055 Professional Center Dr
Orange Park, FL 32073-4461

Mailing address

2055 Professional Center Dr
Orange Park, FL 32073-4461
Phone (904) 276-4500

Other practice location 1

13770 Beach Blvd Ste 6
Jacksonville, FL 32224-7227
Phone (386) 299-6612

Other names 1

  • Alison Lynn Riegner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190405001211 FL Practitioner - Physician Assistant 8426399106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
James S Trimble MD PAGroup PAC ID 0244500544, 4 clinicians

Practice addresses (Care Compare)

2055 Professional Ctr Dr
Orange Park, FL 32073-4461
Phone (904) 276-4500

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1053881995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 PROFESSIONAL CENTER DR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734461",
            "telephone_number": "904-276-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 PROFESSIONAL CENTER DR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734461",
            "telephone_number": "904-276-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13770 Beach Blvd Ste 6",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322247227",
            "country_code": "US",
            "telephone_number": "386-299-6612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODEN",
        "first_name": "ALISON",
        "middle_name": "LYNN",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-04",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALISON",
            "last_name": "RIEGNER",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.