Individual provider Active NPI

Adel Bozorgzadeh, MD

  • Surgery Physician
  • Gillette, WY
National Provider Identifier
1083640825
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
TL8537 Issued in WY
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

Updated by the provider on Jan 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
110081143AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, WY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20081209000103 MA Practitioner - General SurgeryPractitioner - Other (Physician) 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

OrganizationSpecialtyStatusNew patients
Hoskinson Health & Wellness Clinic LLC CurrentSince Dec 18, 2024 Accepting new patients
Massachusetts General Physicians Organization Inc Surgery CurrentSince Mar 24, 2022 Accepting new patients
The General Hospital Corporation CurrentSince Mar 24, 2022 Accepting new patients
Hoskinson Health & Wellness Clinic LLC Current Accepting new patients
NPI 1942083670 CurrentSince Dec 18, 2024 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

  • Direct secure messaging: abozorgzadeh8049@umassmemorial.direct-ci.com
  • FHIR API: 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.

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

Verify at the official NPI Registry.