Individual provider Active NPI

Angela M Bosch, PA

  • Physician Assistant
  • Overland Park, KS
National Provider Identifier
1265509509
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1500775 Issued in KS
Practice address
7901 W 135TH St
Overland Park, KS 66223-1201
Phone
(913) 451-7546
Fax
(913) 663-2411
NPI assigned
Nov 30, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 1500775 KS Primary

Addresses

Primary practice location

7901 W 135TH St
Overland Park, KS 66223-1201

Mailing address

11550 Granada St
Leawood, KS 66211-1453
Phone (913) 451-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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 1

Enrollment IDStateProvider typePAC IDDetails
I20120104000235 KS Practitioner - Physician Assistant 2163497371 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11550 Granada St
Leawood, KS 66211-1453
Phone (913) 451-7546

7901 W 135TH St
Overland Park, KS 66223-1201
Phone (913) 451-7546

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1500775KSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology and Skin Cancer Specialists, LLC CurrentSince Aug 16, 2004 Accepting new patients
Skin & Mohs Surgery Center, LLC Current Accepting new patients

Locations

11550 Granada St
Leawood, KS 66211
Phone (913) 451-7546

7901 W 135th St
Overland Park, KS 66223
Phone (913) 451-7546

2829 S Jackson Ave
Joplin, MO 64804
Phone (417) 623-5111

3435 E 7th St
Joplin, MO 64801
Phone (417) 642-6225

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1265509509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11550 GRANADA ST",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662111453",
            "telephone_number": "913-451-7546",
            "fax_number": "913-663-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 W 135TH ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662231201",
            "telephone_number": "913-451-7546",
            "fax_number": "913-663-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSCH",
        "first_name": "ANGELA",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "1500775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.