NPIMap

Individual provider Active NPI

Kyle Daniel Bomboy, PAC

  • Physician Assistant
  • York, PA
National Provider Identifier
1174041305
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2350 Freedom Way Ste 202
York, PA 17402-8202
Phone
(717) 851-2465
Fax
(717) 741-3043
NPI assigned
Sep 8, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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 Primary

Addresses

Primary practice location

2350 Freedom Way Ste 202
York, PA 17402-8202

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 851-1405

Other practice location 1

1001 S George St Ste 202
York, PA 17403-3676
Phone (717) 851-2465

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171129001263 PA Practitioner - Physician Assistant 3072870047 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

1001 S George St
York, PA 17403-3676

1001 S George St 2ND Floor
Wellspan Pulmonary and Sleep Medicine
York, PA 17403-3676
Phone (717) 851-2465

2350 Freedom Way
Suite 202
York, PA 17402-8202
Phone (717) 851-2465

25 Monument Rd
York, PA 17403-5073

2618 E Market St
Autumn House
York, PA 17403
Phone (717) 845-7214

914 W Market St
Autumn House West
York, PA 17403
Phone (717) 845-7214

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Nov 20, 2017 Accepting new patients
Wellspan Medical Group CurrentSince Nov 20, 2017 Accepting new patients

Locations

1001 S George St
Ste 202
York, PA 17403

1600 S George St
York, PA 17403
Phone (717) 848-3615

2350 Freedom Way
Ste 202
York, PA 17402
Phone (717) 851-1543

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

3421 Concord Rd
York, PA 17402
Phone (717) 851-2441

Interoperability endpoints

  • Direct secure messaging: kbomboy134465@wellspan.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1504828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1174041305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 FREEDOM WAY STE 202",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174028202",
            "telephone_number": "717-851-2465",
            "fax_number": "717-741-3043"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 S George St Ste 202",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174033676",
            "country_code": "US",
            "telephone_number": "717-851-2465",
            "fax_number": "717-741-3043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOMBOY",
        "first_name": "KYLE",
        "middle_name": "DANIEL",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-08",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in York, PA

Sources for this page

Verify at the official NPI Registry.