Active NPI
Caroline Grace Bogan, PA-C
- Physician Assistant
- Glen Allen, VA
National Provider Identifier
1083598379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 3960 Stillman Pkwy
Glen Allen, VA 23060-4197 - Phone
- (843) 693-9395
- NPI assigned
- Aug 1, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
3960 Stillman Pkwy
Glen Allen, VA 23060-4197
Mailing address
821 Bonito Dr
Fripp Island, SC 29920-7058
Phone (843) 693-9395
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251226000430 | VA | Order and Referring Only - Physician Assistant | 6002302213 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755475200000",
"number": "1083598379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 BONITO DR",
"city": "FRIPP ISLAND",
"state": "SC",
"postal_code": "299207058",
"telephone_number": "843-693-9395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3960 STILLMAN PKWY",
"city": "GLEN ALLEN",
"state": "VA",
"postal_code": "230604197",
"telephone_number": "843-693-9395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGAN",
"first_name": "CAROLINE",
"middle_name": "GRACE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-01",
"last_updated": "2025-08-18",
"certification_date": "2025-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Allen, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; 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.