Individual provider Active NPI

Kyle Bowman, PA-C

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1174019012
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C06996 Issued in MD
Practice address
235 South 33Rd Street
Philadelphia, PA 19104-6322
Phone
(717) 497-7025
NPI assigned
Jul 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C06996 MD Primary

Addresses

Primary practice location

235 South 33Rd Street
Philadelphia, PA 19104-6322

Mailing address

235 South 33Rd Street
Philadelphia, PA 19104-6322
Phone (717) 497-7025

Other practice location 1

1800 Orleans St
Baltimore, MD 21287-0010
Phone (717) 497-7025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181227000775 MD Practitioner - Physician Assistant 4880939529 Reassigns benefits to 1 organization
I20240216004142 PA Practitioner - Physician Assistant 4880939529 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

145 King of Prussia Rd
Radnor, PA 19087-4557

145 King of Prussia Rd 201
Radnor, PA 19087-4557

145 King of Prussia Rd 203
Radnor, PA 19087-4557

145 King of Prussia Rd 302
GYN/Onc Radnor
Radnor, PA 19087-4557
Phone (610) 902-2500

145 King of Prussia Rd N
G102 Oto Surgery Radnor
Philadelphia, PA 19087-4557
Phone (610) 902-5500

145 King of Prussia Rd N G
1 Rad Onc Rdanor
Radnor, PA 19087-4557
Phone (610) 902-4580

145 King of Prussia Road G-103
Oral/Maxillo Surg Radnor
Radnor, PA 19087-4557
Phone (610) 902-2100

235 S 33Rd St
Philadelphia, PA 19104-6322
Phone (215) 662-3340

3400 Spruce St
Philadelphia, PA 19104-4206

3400 Spruce Street 5 White BLDG
Oral and Maxillofacial Surgery Hup
Philadelphia, PA 19104-4206
Phone (215) 829-6079

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.31 of 100Reported as group
Quality
73.89
Promoting interoperability
100
Improvement activities
40
Cost
70.47

Merit-based Incentive Payment System (MIPS)

Final score
84.91 of 100Reported as group
Quality
73.58
Promoting interoperability
100
Improvement activities
40
Cost
76.13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University CurrentSince Dec 3, 2018 Accepting new patients
Johns Hopkins University CurrentSince Dec 3, 2018 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 12, 2024 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 12, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

4940 Eastern Ave
Bldg LE1
Baltimore, MD 21224

4940 Eastern Ave
Bldg LEV1
Baltimore, MD 21224

4940 Eastern Ave
Baltimore, MD 21224

601 N Caroline St
Baltimore, MD 21287
Phone (410) 955-5080

1800 Orleans St
Baltimore, MD 21287
Phone (410) 502-2037

6201 Greenleigh Ave
Middle River, MD 21220
Phone (410) 933-2704

235 S 33rd St
Philadelphia, PA 19104
Phone (215) 615-4400

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1530576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1174019012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 SOUTH 33RD STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191046322",
            "telephone_number": "717-497-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 SOUTH 33RD STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191046322",
            "telephone_number": "717-497-7025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Orleans St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212870010",
            "country_code": "US",
            "telephone_number": "717-497-7025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOWMAN",
        "first_name": "KYLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-03",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C06996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.