Organization Active NPI

Bohemian Concierge Care

  • Family Medicine Physician
  • Sebastopol, CA
National Provider Identifier
1194309302
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BOHEMIAN CONCIERGE CARE
Practice address
555 Petaluma Ave Ste B
Sebastopol, CA 95472-4225
Phone
(707) 239-9257
NPI assigned
May 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Authorized official

Name
Elizabeth Flower, MDNPI 1538173141
Title
Physician / Owner
Phone
(707) 239-9257

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

555 Petaluma Ave Ste B
Sebastopol, CA 95472-4225

Mailing address

555 Petaluma Ave Ste B
Sebastopol, CA 95472-4225
Phone (707) 239-9257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210715001829 CA Part B Supplier - Clinic/Group Practice 9638571466 Receives reassigned benefits from 1 practitioner
Practice locations: Sebastopol, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2244713Bohemian Concierge Care Inc555 Petaluma Ave Suite B-3, Sebastopol, CA 95472Certificate of waiverDec 3, 2027

National Provider Directory

National Provider Directory

Locations

555 Petaluma Ave
Ste B3
Sebastopol, CA 95472
Phone (405) 401-5840

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1194309302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 PETALUMA AVE STE B",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724225",
            "telephone_number": "707-239-9257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 PETALUMA AVE STE B",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724225",
            "telephone_number": "707-239-9257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOHEMIAN CONCIERGE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "FLOWER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "PHYSICIAN / OWNER",
        "authorized_official_telephone_number": "707-239-9257",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sebastopol, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.