Active NPI
Bryan A Bohling, M.D.
- Pediatrics Physician
- Longview, WA
National Provider Identifier
1356307250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD00045338
- Practice address
- 971 11TH Ave
Longview, WA 98632-2503 - Phone
- (360) 423-6140
- Fax
- (360) 423-1405
- NPI assigned
- Apr 21, 2006
- Last updated
- Oct 12, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD00045338 | WA | Primary |
Addresses
Primary practice location
971 11TH Ave
Longview, WA 98632-2503
Mailing address
971 11TH Ave
Longview, WA 98632-2503
Phone (360) 423-6140
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1122415 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00045338 | WA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
Locations
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
Organizations & group practices 3
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": "1145577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476230400000",
"number": "1356307250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "971 11TH AVE",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986322503",
"telephone_number": "360-423-6140",
"fax_number": "360-423-1405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "971 11TH AVE",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986322503",
"telephone_number": "360-423-6140",
"fax_number": "360-423-1405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOHLING",
"first_name": "BRYAN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-21",
"last_updated": "2016-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WA",
"license": "MD00045338",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1122415",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.