NPIMap

Individual provider Active NPI

Kippy Marie Bodosky

  • Family Nurse Practitioner
  • Albion, PA
National Provider Identifier
1265950307
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP017869 Issued in PA
Practice address
210 E State St
Albion, PA 16401-1306
Phone
(814) 756-3434
Fax
(814) 756-4725
NPI assigned
Sep 8, 2017
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
Family Nurse Practitioner 363LF0000X SP017869 PA Primary

Addresses

Primary practice location

210 E State St
Albion, PA 16401-1306

Mailing address

210 E State St
Albion, PA 16401-1306
Phone (814) 756-3434

Other names 1

  • Kippy Adsit Bodosky Professional name

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
I20171229000436 PA Practitioner - Nurse Practitioner 0042578775 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Millcreek Community HospitalGroup PAC ID 8426020173, 67 clinicians

Practice addresses (Care Compare)

210 E State St
Albion, PA 16401-1306
Phone (814) 756-3434

Hospital & facility affiliations

  • Lecom Medical Center and Behavioral Health Pav Hospital, Erie, PA, CCN 390198
  • Saint Vincent Hospital Hospital, Erie, PA, CCN 390009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP017869PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates of Erie CurrentSince Nov 27, 2017 Accepting new patients
Millcreek Community Hospital CurrentSince Jun 3, 2024 Accepting new patients
Millcreek Community Hospital Current Accepting new patients
Medical Associates of Erie CurrentSince Nov 27, 2017 Accepting new patients
Millcreek Community Hospital Family CurrentSince Jun 3, 2024 Accepting new patients
Millcreek Community Hospital Current Accepting new patients
Medical Associates of Erie Current Accepting new patients

Locations

210 E State St
Albion, PA 16401
Phone (814) 756-3434

2625 Parade St
Erie, PA 16504
Phone (814) 452-6383

1 Lecom Pl
Erie, PA 16505

5515 Peach St
Erie, PA 16509
Phone (814) 864-4031

Interoperability endpoints

  • Direct secure messaging: kbodosky@maoeim-pa.direct.office.nextgen.com

Organizations & group practices 27

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.

View all 27

Hospital & facility affiliations 10

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": "1658361600000",
    "number": "1265950307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E STATE ST",
            "city": "ALBION",
            "state": "PA",
            "postal_code": "164011306",
            "telephone_number": "814-756-3434",
            "fax_number": "814-756-4725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E STATE ST",
            "city": "ALBION",
            "state": "PA",
            "postal_code": "164011306",
            "telephone_number": "814-756-3434",
            "fax_number": "814-756-4725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODOSKY",
        "first_name": "KIPPY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP017869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIPPY",
            "last_name": "BODOSKY",
            "middle_name": "ADSIT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Albion, PA

Sources for this page

Verify at the official NPI Registry.