Bryn Boswell

Primary specialty

DentistTaxonomy code 122300000X

License

1001637 Issued in WI

Practice address

370 3Rd Ave S
Park Falls, WI 54552-1228

Phone

(715) 762-2188

NPI assigned

Jul 23, 2017

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 19, 2019 through Nov 19, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Northwoods Dentistry, S.C.

  • Dentist
  • Phillips, WI
  • NPI 1063859114
  NPD (past)
• Diamond Trail Dental PC

  • Dental Clinic/Center
  • Montezuma, IA
  • NPI 1164761698
  NPD (past)
• Town Square Dental Care, PC

  • Dental Clinic/Center
  • Oskaloosa, IA
  • NPI 1073780417
  NPD (past)

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

{
    "created_epoch": "1500768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1417470352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "PHILLIPS",
            "state": "WI",
            "postal_code": "545550010",
            "telephone_number": "715-339-3021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 3RD AVE S",
            "city": "PARK FALLS",
            "state": "WI",
            "postal_code": "545521228",
            "telephone_number": "715-762-2188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "605 Peterson Dr",
            "address_purpose": "LOCATION",
            "city": "Phillips",
            "state": "WI",
            "postal_code": "545551430",
            "country_code": "US",
            "telephone_number": "715-339-3021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "720 Garfield Ave",
            "address_purpose": "LOCATION",
            "city": "Ladysmith",
            "state": "WI",
            "postal_code": "548481271",
            "country_code": "US",
            "telephone_number": "715-532-7054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSWELL",
        "first_name": "BRYN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Back-N-Action Physical Therapy and Rehab Specialists
• Back-N-Action PT LLC
• Tyler H. Berkey, DMD
• Alexandra Bice, LPC
• Joseph F Boero, MD
• Rebecca Lynn Brown, PTA
• Mike Jay Charlier, OTR
• Chequamegon School District
• Chiropractic Health Service SC
• Debra L. Ciasulli, M.D.

• Dentist in Park Falls, WI
• Providers in Park Falls, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.