Individual provider Active NPI

Jyothirmai Bobba

  • Family Medicine Physician
  • Kalamazoo, MI
National Provider Identifier
1710060066
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301079796 Issued in MI
Practice address
5973 Beatrice Dr
Kalamazoo, MI 49009-9583
Phone
(269) 286-7110
Fax
(269) 286-7111
NPI assigned
Oct 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301079796 MI Primary
Emergency Medicine Physician 207P00000X 4301079796 MI

Addresses

Primary practice location

5973 Beatrice Dr
Kalamazoo, MI 49009-9583

Mailing address

5943 Stadium Dr
Suite 1
Kalamazoo, MI 49009-3016

Other practice location 1

7901 Angling Rd
Portage, MI 49024-0714
Phone (269) 324-8600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050617000393 MI Practitioner - Family Practice 8628012853 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bronson Methodist HospitalGroup PAC ID 0244148633, 721 clinicians

Practice addresses (Care Compare)

5973 Beatrice Dr
Kalamazoo, MI 49009-9583
Phone (269) 286-7110

Hospital & facility affiliations

  • Bronson at Home Healthcare Services Home health agency, Battle Creek, MI, CCN 237028
  • Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017
  • Bronson Lakeview Hospital Hospital, Paw Paw, MI, CCN 231332
  • Bronson Battle Creek Hospital Hospital, Battle Creek, MI, CCN 230075

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301079796MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group Promed Family Medicine CurrentSince May 5, 2008 Accepting new patients
Bronson Methodist Hospital CurrentSince Jul 1, 2020 Accepting new patients
Promed Healthcare CurrentSince May 5, 2008 Accepting new patients

Locations

3198 Solutions Ctr
Chicago, IL 60677

6565 W Main St
Kalamazoo, MI 49009
Phone (269) 375-0400

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

5973 Beatrice Dr
Kalamazoo, MI 49009
Phone (269) 286-7110

5943 Stadium Dr
Ste 1
Kalamazoo, MI 49009
Phone (269) 552-2836

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

7901 Angling Rd
Ste B-201
Portage, MI 49024
Phone (269) 324-8600

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 3

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1710060066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5943 STADIUM DR",
            "address_2": "SUITE 1",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5973 BEATRICE DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490099583",
            "telephone_number": "269-286-7110",
            "fax_number": "269-286-7111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7901 Angling Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "MI",
            "postal_code": "490240714",
            "country_code": "US",
            "telephone_number": "269-324-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOBBA",
        "first_name": "JYOTHIRMAI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301079796",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301079796",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson HealthCare Group Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.