Bose S. Mikkilineni, M.D. FACS

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

12282 Issued in WV

Practice address

419 Carriage Dr
Beckley, WV 25801-2805

Phone

(304) 253-8416

Fax

(866) 461-4726

NPI assigned

Sep 5, 2005

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

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in WV

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1184/brand/1/csg/1/fhir/r4
• Direct secure messaging: bose.mikkilineni@wvafn.hcadirect.net

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.

• Dr. Bose S. Mikkilineni, M.D. Facs

  • Surgery Physician
  • Beckley, WV
  • NPI 1124141171
  NPD (past)

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

{
    "created_epoch": "1125878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370304000000",
    "number": "1407840549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012805",
            "telephone_number": "304-253-8416",
            "fax_number": "866-461-4726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012805",
            "telephone_number": "304-253-8416",
            "fax_number": "866-461-4726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKKILINENI",
        "first_name": "BOSE",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "M.D. FACS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-05",
        "last_updated": "2013-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WV",
            "license": "12282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "001720379",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "020002556",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL COMPENSATION #",
            "identifier": "151389100",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "550631859",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "68790",
            "identifier": "68790",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "231835",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "49236",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0128502000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS",
            "identifier": "151389100",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6441144",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Beckley, WV
• Providers in Beckley, WV by specialty
• Surgery Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; 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.

Verify at the official NPI Registry.