Active NPI
Kevin Patrick Bogart, PA-C
- Medical Physician Assistant
- Denver, CO
National Provider Identifier
1063733574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 3010
- Practice address
- 301 W 6TH Ave
Family and Internal Medicine Clinic Mc3250
Denver, CO 80204-5182 - Phone
- (303) 602-8070
- Fax
- (303) 602-8176
- NPI assigned
- Jun 18, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3010 | CO | Primary |
Addresses
Primary practice location
301 W 6TH Ave
Family and Internal Medicine Clinic Mc3250
Denver, CO 80204-5182
Mailing address
301 W 6TH Ave
Family and Internal Medicine Clinic - MC 3250
Denver, CO 80204-5182
Phone (303) 602-8070
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91323533 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3010 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310515200000",
"number": "1063733574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 W 6TH AVE",
"address_2": "FAMILY AND INTERNAL MEDICINE CLINIC - MC 3250",
"city": "DENVER",
"state": "CO",
"postal_code": "802045182",
"telephone_number": "303-602-8070",
"fax_number": "303-602-8176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 W 6TH AVE",
"address_2": "FAMILY AND INTERNAL MEDICINE CLINIC MC3250",
"city": "DENVER",
"state": "CO",
"postal_code": "802045182",
"telephone_number": "303-602-8070",
"fax_number": "303-602-8176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGART",
"first_name": "KEVIN",
"middle_name": "PATRICK",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-18",
"last_updated": "2011-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CO",
"license": "3010",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "91323533",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.