Kelly Bossenbroek Fedoriw, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2008-01856 Issued in NC

Practice address

590 Manning Dr
Chapel Hill, NC 27599-6119

Phone

(919) 966-0210

Fax

(919) 966-2126

NPI assigned

Jun 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kelly Bossenbroek Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Medical College of Ohio, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of North Carolina at Chapel HillGroup PAC ID 0648181156, 2,028 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Unc Hospitals Hospital, Chapel Hill, NC, CCN 340061

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kfedoriw32017@direct.unc.nchie.net

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.

• University of North Carolina at Chapel Hill

  • Anesthesiology Physician
  • Chapel Hill, NC
  • NPI 1780669200

  Family Medicine

  Medicare reassignment Care Compare group NPD
• University of North Carolina at Chapel Hill

  • Clinic/Center
  • Chapel Hill, NC
  • NPI 1285689299
  NPD
• University of North Carolina at Chapel Hill

  • Family Medicine Physician
  • Raleigh, NC
  • NPI 1972912285
  NPD
• Park Ophthalmology

  • Ophthalmology Physician
  • Durham, NC
  • NPI 1619150141
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University of North Carolina Hospitals at Chapel Hill

  • General Acute Care Hospital
  • Chapel Hill, NC
  • NPI 1932208576
  Care Compare affiliation

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1285674606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 MANNING DR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275996119",
            "telephone_number": "919-966-0210",
            "fax_number": "919-966-2126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 MANNING DR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275996119",
            "telephone_number": "919-966-0210",
            "fax_number": "919-966-2126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDORIW",
        "first_name": "KELLY",
        "middle_name": "BOSSENBROEK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2008-01856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236346",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kfedoriw32017@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "590 Manning Dr",
            "city": "Chapel Hill",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275996119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "BOSSENBROEK",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alyssa Fawcett, DDS
• Kayla Desiree Feagins, MD
• Mary Clayton Federspiel, CPNP
• Maya Fedhila, DDS
• George Daniel Fedoriw, M.D.
• Justin Aaron Fegley, LAT,ATC
• Julie Ann Feimster, PHARMD
• Amir Feinberg
• Richard H Feins, MD
• Sara Banoo Feizi, MD

• Family Medicine Physician in Chapel Hill, NC
• Providers in Chapel Hill, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.