Marlise Gnutzmann Botelho, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2764 Issued in OH

Practice address

33 W Rahn Rd
Dayton, OH 45429-2219

Phone

(937) 433-8990

Fax

(937) 433-8691

NPI assigned

May 14, 2008

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

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grand Traverse Physician Services PCGroup PAC ID 2466963806, 119 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Medical Center Hospital, Traverse City, MI, CCN 230097

Merit-based Incentive Payment System (MIPS)

Final score

91.82 of 100Reported as group

Quality

79.31

Promoting interoperability

94

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Grand Traverse Physician Services PC

  • Hospitalist Physician
  • Traverse City, MI
  • NPI 1932913217
  Medicare reassignment Care Compare group
• Sound Inpatient Physicians-Michigan, PLLC

  • Internal Medicine Physician
  • Kalamazoo, MI
  • NPI 1093967861
  Medicare reassignment
• Wexford Physician Services PC

  • Hospitalist Physician
  • Cadillac, MI
  • NPI 1649084260
  Medicare reassignment
• Sound Inpatient Physicians-Michigan PLLC

  • Internal Medicine Physician
  • Grayling, MI
  • NPI 1639311996
  NPD

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

• Munson Medical Center

  • General Acute Care Hospital
  • Traverse City, MI
  • NPI 1952307852
  Care Compare affiliation

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1285801647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 W RAHN RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454292219",
            "telephone_number": "937-433-8990",
            "fax_number": "937-433-8691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 W RAHN RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454292219",
            "telephone_number": "937-433-8990",
            "fax_number": "937-433-8691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTELHO",
        "first_name": "MARLISE",
        "middle_name": "GNUTZMANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "2764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jatoya Bostock
• Tashia Shadai Bostock
• Jennifer Boston
• Kimberly Boston, RN
• Dashaya Curshel Boswell
• Felicia Boubin, AUD
• Mikula Bouquett, RN, BSN
• Despina Bourbakis
• Beth Alyson Bourquin, CNP
• Susan Marie Bouska, PHRAM.D.

• Medical Physician Assistant in Dayton, OH
• Providers in Dayton, OH by specialty
• Medical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.