Individual provider Active NPI

Felicia Bosse, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1306331319
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11414 Issued in GA
Practice address
1968 Peachtree Rd NW BLDG 775TH
Atlanta, GA 30309-1281
Phone
(404) 605-4600
NPI assigned
Jun 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 11414 GA Primary

Addresses

Primary practice location

1968 Peachtree Rd NW BLDG 775TH
Atlanta, GA 30309-1281

Mailing address

3800 Reservoir Rd NW
Washington, DC 20007-2113

Other practice location 1

3800 Reservoir Rd NW
Washington, DC 20007-2113
Phone (607) 372-1175

Other names 1

  • Felicia Hertzog Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220224002108 MD Practitioner - Physician Assistant 8921341488 Reassigns benefits to 1 organization
I20230327000782 GA Practitioner - Physician Assistant 8921341488 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Providers LLCGroup PAC ID 9830082825, 526 clinicians

Practice addresses (Care Compare)

1968 Peachtree NW Rd
Atlanta, GA 30309-1281
Phone (404) 605-5000

1968 Peachtree Rd NW
Atlanta, GA 30309-1281

1968 Peachtree Rd NW Atlanta
77 Building Suite 3110
Atlanta, GA 30309-1281
Phone (770) 605-4224

1984 Peachtree Rd NW
Suite 300
Atlanta, GA 30309-5219
Phone (404) 367-3210

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
11414GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC CurrentSince Jan 1, 2022 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jan 1, 2022 Accepting new patients

Locations

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

1630 Main St
Ste 213
Chester, MD 21619
Phone (443) 481-5300

Interoperability endpoints

  • Direct secure messaging: fhertzog133863@direct.aahs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1529625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1306331319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 RESERVOIR RD NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200072113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 PEACHTREE RD NW BLDG 775TH",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091281",
            "telephone_number": "404-605-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 Reservoir Rd NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200072113",
            "country_code": "US",
            "telephone_number": "607-372-1175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSSE",
        "first_name": "FELICIA",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-22",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FELICIA",
            "last_name": "HERTZOG",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.