Individual provider Active NPI

Gabriella Nicole Bodek, PA-C

  • Physician Assistant
  • Chester, PA
National Provider Identifier
1497505945
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1 Medical Center Blvd
Chester, PA 19013-3902
Phone
(610) 447-2000
NPI assigned
Mar 26, 2024
Last updated
Mar 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

1 Medical Center Blvd
Chester, PA 19013-3902

Mailing address

15 Montgomery Ave Apt 9B
Bala Cynwyd, PA 19004-2659
Phone (516) 673-6915

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240506004112 PA Practitioner - Physician Assistant 2365882404 Reassigns benefits to 1 organization
I20250826003631 NY Practitioner - Physician Assistant 2365882404 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Divinity Medical Services PLLCGroup PAC ID 5193030245, 92 clinicians

Practice addresses (Care Compare)

1585 Dutch Broadway
Valley Stream, NY 11580-1333
Phone (516) 490-6300

203 Gramatan Ave
Suite a
Mount Vernon, NY 10550-1291
Phone (914) 202-4830

23315 Hillside Ave
Queens Village, NY 11427-2634
Phone (718) 210-1945

3379 Crompond Rd
Yorktown Heights, NY 10598-3605
Phone (914) 930-5550

3400 Boston Rd
Bronx, NY 10469-2502
Phone (718) 290-8787

464 Atlantic Ave
East Rockaway, NY 11518-1415
Phone (516) 730-3344

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Health Access Network, Inc. CurrentSince May 1, 2024 Accepting new patients
Prospect Health Access Network, Inc. CurrentSince May 1, 2024 Accepting new patients

Locations

1 Medical Center Blvd
Chester, PA 19013
Phone (610) 447-6666

1 Medical Center Blvd
Ste 301
Chester, PA 19013
Phone (610) 566-6744

100 W Sproul Rd
Ste 123
Springfield, PA 19064
Phone (610) 619-8281

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1497505945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MONTGOMERY AVE APT 9B",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190042659",
            "telephone_number": "516-673-6915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "CHESTER",
            "state": "PA",
            "postal_code": "190133902",
            "telephone_number": "610-447-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODEK",
        "first_name": "GABRIELLA",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chester, PA

Sources for this page

Verify at the official NPI Registry.