Brandon Karl Bodlak, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS9633 Issued in FL

Practice address

4410 W Newberry Rd Ste B
Gainesville, FL 32607-2290

Phone

(353) 372-7800

Fax

(352) 372-7800

NPI assigned

Jul 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Specialty

Family Practice

Education

Other, 2005

Medicare assignment

May accept Medicare assignment

Group practices

Family Practice Associates PAGroup PAC ID 7416919352, 4 clinicians

Lake Area Physical Therapy Inc.Group PAC ID 3678604840, 372 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Gainesville, FL, CCN 107486
• HCA Florida North Florida Hospital Hospital, Gainesville, FL, CCN 100204

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GBBJBA/Endpoint/GBBJBA

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.

• Family Practice Associates PA

  • Family Medicine Physician
  • Gainesville, FL
  • NPI 1134151871
  Medicare reassignment Care Compare group NPD
• Lake Area Physical Therapy Inc

  • Physical Therapist
  • Melrose, FL
  • NPI 1376682518
  Care Compare group
• Atlas Diagnostics Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Punta Gorda, FL
  • NPI 1033185889
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• North Florida Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Gainesville, FL
  • NPI 1174579155
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1144251810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 W NEWBERRY RD STE B",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326072290",
            "telephone_number": "352-372-7800",
            "fax_number": "352-372-7879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 W NEWBERRY RD STE B",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326072290",
            "telephone_number": "353-372-7800",
            "fax_number": "352-372-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODLAK",
        "first_name": "BRANDON",
        "middle_name": "KARL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISTA HEALTHPLAN",
            "identifier": "SG081521",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "302712",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "45751",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4664818",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Bobroff
• Scott Bodendorfer, RPH
• Shirley Worth Bodie, MASSAGE THERAPIST
• Bodies in Balance Acupuncture, Inc.
• Latara M Bodison
• Nicole Elizabeth Boehm
• Gretel Boehme, PHARMD
• Andre Pierre Boezaart, MD PHD
• David Bofinger I
• Lydia Bogans

• Family Medicine Physician in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.