Gerald Bossert, PA
Individual provider Active NPI Family Medicine Physician · Payson, AZ
NPI 1700885308 · NPPES record last updated Sep 27, 2007
Key facts
- NPI
- 1700885308
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 1897 (AZ)
- Practice address
- 126 E Main St
Suite D
Payson, AZ 85541-5488 - Phone
- (928) 472-5260
- NPI assigned
- Jul 18, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241121002135 | WA | Practitioner - Physician Assistant | 0446286678 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1091 | AK | MD | Addiction (Substance Use Disorder) Counselor |
| 1897 | AZ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Centers | Current |
Accepting new patients | |
| Family Health Centers | Current |
Accepting new patients | |
| Payson Healthcare Management Inc | Family Medicine | Past |
Accepting new patients |
| Escambia River Emergency Physicians, LLC | Physician Assistant | Past | Accepting new patients |
| Family Health Centers | Past | Accepting new patients | |
| Camai Community Health Center, Inc. | Past |
Accepting new patients | |
| Center for Physical Medicine & Rehabilitation P C | Past | Accepting new patients | |
| Med 97 LLC | Past | Accepting new patients | |
| Alaska Imaging Associates, LLC | Past | Accepting new patients | |
| Coastal Radiology Associates PA | Past | Accepting new patients | |
| Bristol Bay Borough | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/20726/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1897 | AZ | Yes |
| Physician Assistant | 363A00000X | 1897 | AZ |
Addresses
Primary practice location
126 E Main St
Suite D
Payson, AZ 85541-5488
Mailing address
126 E Main St
Suite D
Payson, AZ 85541-5488
Phone (928) 472-5260
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 347220 | Medicaid | AZ |
Other providers in Payson, AZ
- Tyri Norman Blondal
- Sheila Eva Bloomquist
- Bonanza Square Dentistry LLC
- Cynthia D Booth
- Steven Nicholas Booth
- Bruce Boushon
- Robin Bramble
- Michael Evan Brown
- John Bruesewitz
- Paul Alexander Budnick
All providers in Payson, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2007. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.