Active NPI
Jessica Lyn Bodary, MPO, CPO
- Orthotist
- Chula Vista, CA
National Provider Identifier
1083278212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotist
- License
- CPO04202
- Practice address
- 895 Third Ave BLDG 2
Chula Vista, CA 91911-1304 - Phone
- (619) 585-8421
- NPI assigned
- Apr 23, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetist | 224P00000X | CPO04202 | CA | |
| Orthotist | 222Z00000X | CPO04202 | CA | Primary |
Addresses
Primary practice location
895 Third Ave BLDG 2
Chula Vista, CA 91911-1304
Mailing address
4117 Idaho St
San Diego, CA 92104-1805
Phone (517) 528-7549
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CPO04202 | CA | MD | Orthotist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555977600000",
"number": "1083278212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4117 IDAHO ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921041805",
"telephone_number": "517-528-7549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "895 THIRD AVE BLDG 2",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919111304",
"telephone_number": "619-585-8421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODARY",
"first_name": "JESSICA",
"middle_name": "LYN",
"credential": "MPO, CPO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-23",
"last_updated": "2019-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "CA",
"license": "CPO04202",
"primary": false
},
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "CA",
"license": "CPO04202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.