Jeffrey P Boggess, M.D.
Individual provider Active NPI Family Medicine Physician · Bend, OR
NPI 1215048715 · NPPES record last updated Sep 12, 2013
Key facts
- NPI
- 1215048715
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD12449 (OR)
- Practice address
- 1080 Mount Bachelor Dr
Bend, OR 97702-3280 - Phone
- (541) 550-4400
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Owned or controlled facilities with NPI records 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Clearpath Hospice |
Hospice | Corporate Director (100%) | Jun 14, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061228000052 | OR | Practitioner - Family Practice | 1254235443 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD12449 | OR | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD12449 | OR | Yes |
Addresses
Primary practice location
1080 Mount Bachelor Dr
Bend, OR 97702-3280
Mailing address
1501 NE Medical Center Dr
Bend, OR 97701-6051
Phone (541) 382-2811
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00849835 | Other | OR | MEDICARE RAILROAD |
| 075986 | Medicaid | OR |
Other providers in Bend, OR
- Stephen Boe
- Nicholas Song Boehling
- Frederick Peter Boehm
- Laura Boehm
- Madison Boettner
- Bauni Elizabeth Boheme X
- Michel Adeodat Boileau
- Matthew Todd Boire
- Kirsten Boland
- Julia Marie Bolen
All providers in Bend, OR · Family Medicine Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.