Individual provider Active NPI

Martha A Bozeman, LCSW

  • Clinical Social Worker
  • Kissimmee, FL
National Provider Identifier
1699727651
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW 6205 Issued in FL
Practice address
206 Park Place Blvd
Kissimmee, FL 34741-2344
Phone
(407) 846-0023
Fax
(407) 483-1064
NPI assigned
May 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW 6205 FL Primary

Addresses

Primary practice location

206 Park Place Blvd
Kissimmee, FL 34741-2344

Mailing address

206 Park Place Blvd
Kissimmee, FL 34741-2344
Phone (407) 846-0023

Other identifiers 2

IdentifierTypeStateIssuer
Z083GOtherFLBCBS
7678878MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050822000198 FL Practitioner - Clinical Social Worker 0941230775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osceola Mental Health IncGroup PAC ID 2062313703, 14 clinicians

Practice addresses (Care Compare)

206 Park Place Blvd
Kissimmee, FL 34741-2344
Phone (407) 846-0023

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW 6205FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Osceola Mental Health Inc CurrentSince Dec 15, 2005 Accepting new patients

Locations

1507 Bill Beck Blvd
Kissimmee, FL 34744
Phone (407) 943-8618

200 Park Place Blvd
Kissimmee, FL 34741
Phone (407) 846-0023

206 Park Place Blvd
Kissimmee, FL 34741
Phone (407) 846-0023

2940 Pleasant Hill Rd
Kissimmee, FL 34746
Phone (407) 846-0023

208 Park Place Blvd
Kissimmee, FL 34741
Phone (321) 900-3074

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699727651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 PARK PLACE BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347412344",
            "telephone_number": "407-846-0023",
            "fax_number": "407-483-1064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 PARK PLACE BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347412344",
            "telephone_number": "407-846-0023",
            "fax_number": "407-483-1064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOZEMAN",
        "first_name": "MARTHA",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW 6205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Z083G",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7678878",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.