Jeffery Bossenberger, D.O.
Individual provider Active NPI Family Medicine Physician · Fenton, MI
NPI 1467520163 · NPPES record last updated Nov 29, 2018
Key facts
- NPI
- 1467520163
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 5101012104 (MI)
- Practice address
- 17200 Silver Pkwy
Fenton, MI 48430-4437 - Phone
- (810) 714-9660
- Fax
- (810) 714-9661
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Michigan State University College of Osteopathic Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- McLaren Medical Group
Practice addresses (Care Compare)
401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-2000
Hospital & facility affiliations
- McLaren Hospice
- McLaren Flint
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050810000136 | MI | Practitioner - Family Practice | 3779512728 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McLaren Medical Group | Current |
Accepting new patients | |
| McLaren Medical Group | Family Medicine | Current |
Accepting new patients |
| Genesys Integrated Group Practice PC | Past | Accepting new patients | |
| McLaren Medical Group | Family Medicine | Past | Accepting new patients |
| Ascension Genesys Hospital | Past | Accepting new patients |
Locations
39373 Garfield Rd
Clinton Twp, MI 48038
Phone (586) 286-4880
401 S Ballenger Hwy
Flint, MI 48532
Phone (810) 342-1000
Interoperability endpoints
- https://api.platform.athenahealth.com/8209/brand/5/csg/21/fhir/r4
- jefferybossenberger@pfmc.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101012104 | MI | Yes |
Addresses
Primary practice location
17200 Silver Pkwy
Fenton, MI 48430-4437
Mailing address
17200 Silver Pkwy
Fenton, MI 48430-3423
Phone (810) 714-9660
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3278563 | Medicaid | MI |
Other providers in Fenton, MI
- Rebeccah May Border
- Bormans Inc
- Bormans Inc
- Megan Bosma
- Carlton O Bosse
- Ellen Bowlin
- Judy Gaye Boyer
- Amy Lynn Bray
- Brittani Rose Brenner
- Anna Brewer
All providers in Fenton, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.