Jose Bossbaly, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD040261L Issued in PA

Practice address

136 Diamond St
Philadelphia, PA 19122-1721

Phone

(215) 426-8100

Fax

(215) 965-2344

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

Yes

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 PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Dr. Max E. Mercado Practice, LLCGroup PAC ID 9739251315, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Mercado Medical Practice LLC

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1629160742
  Medicare reassignment Care Compare group NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541548800000",
    "number": "1376551101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 DIAMOND ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191221721",
            "telephone_number": "215-426-8100",
            "fax_number": "215-965-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 DIAMOND ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191221721",
            "telephone_number": "215-426-8100",
            "fax_number": "215-965-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSSBALY",
        "first_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2018-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD040261L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Bosley, LBS
• Peter Bosniak, PA-C
• Joshua William Bosque-Hamilton, MD, MS
• Brandon Alfredo Bosque, D.P.M.
• Connor Samuel Bossard
• Jaie Bosse, ND
• Kristopher Bosse, MD
• John Vincent Bosso, MD
• Heather Bostancic, CRNA
• Boston Brace International Inc. (OP Specialty Bracing)

• Internal Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; 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.