Jackie M. Bosworth, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

P56991 Issued in NY

Practice address

1 Brookdale PLZ
Brooklyn, NY 11212-3139

Phone

(718) 240-8075

NPI assigned

Jul 10, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• New Horizon Counseling Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • South Ozone Park, NY
  • NPI 1366430563
  Medicare reassignment NPD
• Rising Ground. Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brooklyn, NY
  • NPI 1447607817
  Medicare reassignment NPD
• Rising Ground. Inc

  • Voluntary or Charitable Agency
  • Yonkers, NY
  • NPI 1710957683
  NPD (past)

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

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247184000000",
    "number": "1780813816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W 92ND ST",
            "address_2": "APT. 5A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100257432",
            "telephone_number": "212-787-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BROOKDALE PLZ",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112123139",
            "telephone_number": "718-240-8075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSWORTH",
        "first_name": "JACKIE",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-10",
        "last_updated": "2009-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "P56991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claire Bostrom, LMSW
• Elsa Janice Boswell
• Hannah Boswell, LMSW
• Sade Boswell
• Hillery Bosworth, M.D.
• Vedika Manoj Botadra, PT, MS
• Jadyn Botchick
• John Andrew Botello-Patino
• Nathalia Botero, MD
• Safia H Boti, FNP

• Psychiatry Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.