Active NPI
Dylan Jordan Bogotty
- Behavior Technician
- Crystal, MN
National Provider Identifier
1689370892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 4825 58TH Ave N
Crystal, MN 55429-2821 - Phone
- (701) 213-0726
- NPI assigned
- Jan 31, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
4825 58TH Ave N
Crystal, MN 55429-2821
Mailing address
4825 58TH Ave N
Crystal, MN 55429-2821
Phone (701) 213-0726
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675123200000",
"number": "1689370892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4825 58TH AVE N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554292821",
"telephone_number": "701-213-0726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4825 58TH AVE N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554292821",
"telephone_number": "701-213-0726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGOTTY",
"first_name": "DYLAN",
"middle_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-31",
"last_updated": "2023-01-31",
"certification_date": "2023-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.