NPIMap

Individual provider Active NPI

Brent Boggess, MD

  • Family Medicine Physician
  • Saginaw, MI
National Provider Identifier
1407852064
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
BB050524 Issued in MI
Practice address
3570 Shattuck Rd
Saginaw, MI 48603-3153
Phone
(989) 792-5353
Fax
(989) 792-3033
NPI assigned
Jun 28, 2005
Last updated
Apr 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X BB050524 MI Primary

Addresses

Primary practice location

3570 Shattuck Rd
Saginaw, MI 48603-3153

Mailing address

3570 Shattuck Rd
Saginaw, MI 48603-3153
Phone (989) 792-5353

Other identifiers 1

IdentifierTypeStateIssuer
3208531MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address brentboggess@smomsjhs.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110114001050 MI Practitioner - Family Practice 7315136751 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center SaginawGroup PAC ID 6305737156, 111 clinicians

Practice addresses (Care Compare)

3570 Shattuck Rd
Saginaw, MI 48603-3153
Phone (989) 792-5353

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
BB050524MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Saginaw Family Medicine Current Accepting new patients
Mymichigan Medical Center Saginaw CurrentSince Jan 1, 1996 Accepting new patients
Mymichigan Medical Center Saginaw Family Medicine CurrentSince Jan 1, 1996 Accepting new patients
Mymichigan Medical Center Saginaw Past Accepting new patients
Mymichigan Medical Center Saginaw Past Accepting new patients
Mymichigan Medical Center Saginaw Family Medicine Past Accepting new patients

Locations

4040 N Euclid Ave
Ste B
Bay City, MI 48706
Phone (989) 671-9153

9900 Birch Run Rd
Birch Run, MI 48415
Phone (989) 624-1500

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

3570 Shattuck Rd
Saginaw, MI 48603
Phone (989) 792-5353

Interoperability endpoints

  • Direct secure messaging: brent.boggess.1@11016.direct.athenahealth.com

Organizations & group practices 6

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.

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": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1407852064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3570 SHATTUCK RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486033153",
            "telephone_number": "989-792-5353",
            "fax_number": "989-792-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3570 SHATTUCK RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486033153",
            "telephone_number": "989-792-5353",
            "fax_number": "989-792-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGGESS",
        "first_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "BB050524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3208531",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "brentboggess@smomsjhs.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "3570 Shattuck Rd",
            "city": "Saginaw",
            "state": "MI",
            "country_code": "US",
            "postal_code": "486033153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.