Jennifer Bogen

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

7501008414 Issued in MI

Practice address

106 S Stewart Ave
Fremont, MI 49412-1624

Phone

(231) 924-3456

Fax

(231) 924-3443

NPI assigned

Nov 15, 2016

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 15, 2016.

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479168000000",
    "number": "1265974752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8054 MEINERT PARK RD",
            "city": "MONTAGUE",
            "state": "MI",
            "postal_code": "494378708",
            "telephone_number": "231-924-3456",
            "fax_number": "231-924-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 S STEWART AVE",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121624",
            "telephone_number": "231-924-3456",
            "fax_number": "231-924-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGEN",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-15",
        "last_updated": "2016-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501008414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.