Individual provider Active NPI

Kristi Bose, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Omaha, NE
National Provider Identifier
1336680396
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
112187 Issued in NE
Practice address
11404 W Dodge Rd Ste 300
Omaha, NE 68154-2511
Phone
(402) 898-1113
Fax
(402) 819-5588
NPI assigned
Mar 10, 2017
Last updated
Jan 6, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 112187 NE Primary

Addresses

Primary practice location

11404 W Dodge Rd Ste 300
Omaha, NE 68154-2511

Mailing address

11404 W Dodge Rd Ste 300
Omaha, NE 68154-2511
Phone (402) 898-1113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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

Enrollment IDStateProvider typePAC IDDetails
I20170503001969 NE Practitioner - Nurse Practitioner 9537446307 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Verve Collaborative Health LLCGroup PAC ID 3779811989, 9 clinicians

Practice addresses (Care Compare)

11404 W Dodge Rd
Suite 300
Omaha, NE 68154-9603
Phone (402) 898-1113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Omaha Integrative Care, LLC CurrentSince Mar 29, 2017 Accepting new patients

Locations

1812 N 169th Plz
Omaha, NE 68118
Phone (402) 934-1617

2126 N 117th Ave
Omaha, NE 68164
Phone (402) 934-1617

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8127/brand/1/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1489104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1336680396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11404 W DODGE RD STE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681542511",
            "telephone_number": "402-898-1113",
            "fax_number": "402-819-5588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11404 W DODGE RD STE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681542511",
            "telephone_number": "402-898-1113",
            "fax_number": "402-819-5588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSE",
        "first_name": "KRISTI",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-10",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NE",
            "license": "112187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.