Individual provider Active NPI

Mary J Bosker, PHD

  • Psychologist
  • San Diego, CA
National Provider Identifier
1295902906
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
21590 Issued in CA
Practice address
6386 Alvarado CT Ste 210
San Diego, CA 92120-4907
Phone
(858) 279-1223
NPI assigned
May 12, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 21590 CA Primary

Addresses

Primary practice location

6386 Alvarado CT Ste 210
San Diego, CA 92120-4907

Mailing address

6386 Alvarado CT Ste 210
San Diego, CA 92120-4907

Other practice location 1

34800 Bob Wilson Dr
Nmcsd
San Diego, CA 92134-1098
Phone (619) 532-8250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240902000324 CA Practitioner - Clinical Psychologist 0244412971 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

6386 Alvarado CT
Suite 210
San Diego, CA 92120-4907
Phone (858) 279-1223

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
21590CAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Psychiatric Associates Inc CurrentSince Jul 20, 2024 Accepting new patients

Locations

8881 Fletcher Pkwy
Ste 350
La Mesa, CA 91942
Phone (619) 465-9792

6386 Alvarado Ct
Ste 210
San Diego, CA 92120
Phone (619) 286-6687

490 Post St
Ste 1043
San Francisco, CA 94102
Phone (415) 409-0944

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1295902906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6386 ALVARADO CT STE 210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921204907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6386 ALVARADO CT STE 210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921204907",
            "telephone_number": "858-279-1223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34800 Bob Wilson Dr",
            "address_2": "NMCSD",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921341098",
            "country_code": "US",
            "telephone_number": "619-532-8250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSKER",
        "first_name": "MARY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-12",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "21590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.