Active NPI
Adel Bozorgzadeh, MD
- Surgery Physician
- Gillette, WY
National Provider Identifier
1083640825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- TL8537
- Practice address
- 469 Highway 50
Gillette, WY 82718-9330 - Phone
- (307) 387-9850
- Fax
- (307) 387-9890
- NPI assigned
- Jun 23, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Transplant Surgery Physician | 204F00000X | 238379 | MA | |
| Surgery Physician | 208600000X | TL8537 | WY | Primary |
Addresses
Primary practice location
469 Highway 50
Gillette, WY 82718-9330
Mailing address
201 W Lakeway Rd Ste 1004
Gillette, WY 82718-6349
Phone (307) 387-9850
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110081143A | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA, WY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081209000103 | MA | Practitioner - General Surgery | 9133137466 | Reassigns benefits to 2 organizations |
| I20241220001241 | WY | Practitioner - General Surgery | 9133137466 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hoskinson Health & Wellness Clinic LLC | Current | Accepting new patients | |
| Massachusetts General Physicians Organization Inc | Surgery | Current | Accepting new patients |
| The General Hospital Corporation | Current | Accepting new patients | |
| Hoskinson Health & Wellness Clinic LLC | Current | Accepting new patients | |
| NPI 1942083670 | Current | Accepting new patients | |
| Umass Memorial Medical Center, Inc. | Past | Accepting new patients |
Locations
55 Fruit St
Boston, MA 02114
55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967
469 Wyoming Highway 50
Gillette, WY 82718
Phone (307) 387-9850
201 W Lakeway Rd
Ste 1004
Gillette, WY 82718
Phone (307) 387-9850
Interoperability endpoints
- abozorgzadeh8049@umassmemorial.direct-ci.com
- https://api.platform.athenahealth.com/26742/brand/1/csg/1/fhir/r4
Organizations & group practices 5
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.
-
- Dermatology Physician
- Boston, MA
- NPI 1801874573
MA, Surgery
-
- Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
- Gillette, WY
- NPI 1003628611
-
- Psychiatric Hospital Unit
- Worcester, MA
- NPI 1689760092
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735776000000",
"number": "1083640825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 W LAKEWAY RD STE 1004",
"city": "GILLETTE",
"state": "WY",
"postal_code": "827186349",
"telephone_number": "307-387-9850",
"fax_number": "307-387-9890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "469 HIGHWAY 50",
"city": "GILLETTE",
"state": "WY",
"postal_code": "827189330",
"telephone_number": "307-387-9850",
"fax_number": "307-387-9890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOZORGZADEH",
"first_name": "ADEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-23",
"last_updated": "2025-01-02",
"certification_date": "2025-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "204F00000X",
"taxonomy_group": "",
"desc": "Transplant Surgery",
"state": "MA",
"license": "238379",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WY",
"license": "TL8537",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110081143A",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Gillette, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.