Active NPI
Gail P Bosco, PA
- Medical Physician Assistant
- Green Bay, WI
National Provider Identifier
1538205380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 2092
- Practice address
- 2430 E Mason St
Green Bay, WI 54302-3759 - Phone
- (920) 406-9863
- NPI assigned
- Jan 29, 2007
- Last updated
- Apr 9, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 2092 | WI | Primary |
Addresses
Primary practice location
2430 E Mason St
Green Bay, WI 54302-3759
Mailing address
2430 E Mason St
Green Bay, WI 54302-3759
Phone (920) 406-9863
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41935400 | Medicaid | WI | |
| 2092 | Other | WI | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2092 | WI | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397001600000",
"number": "1538205380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2430 E MASON ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543023759",
"telephone_number": "920-406-9863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2430 E MASON ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543023759",
"telephone_number": "920-406-9863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSCO",
"first_name": "GAIL",
"middle_name": "P",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2014-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WI",
"license": "2092",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41935400",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "2092",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.