Individual provider Active NPI

Ottilia Boros, FNP-C

  • Family Medicine Physician
  • Bangor, ME
National Provider Identifier
1821826371
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
CNP241459 Issued in ME
Practice address
1012 Union St
Bangor, ME 04401-3060
Phone
(207) 404-8100
NPI assigned
Jul 25, 2024
Last updated
Sep 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X CNP241459 ME Primary

Addresses

Primary practice location

1012 Union St
Bangor, ME 04401-3060

Mailing address

PO Box 1599
Bangor, ME 04402-1599

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240911004210 ME Practitioner - Nurse Practitioner 9335689785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

1012 Union St
Bangor, ME 04401-3058

1068 Union St
Bangor, ME 04401-3016
Phone (207) 404-8181

242 Brunswick St
Old Town, ME 04468-1613
Phone (207) 827-6128

992 Union St
Bangor, ME 04401-3057

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CNP241459MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center CurrentSince Sep 4, 2024 Accepting new patients
Penobscot Community Health Center Current Accepting new patients
Penobscot Community Health Center CurrentSince Sep 4, 2024 Accepting new patients

Locations

1012 Union St
Bangor, ME 04401
Phone (207) 404-8200

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1721865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1821826371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 UNION ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013060",
            "telephone_number": "207-404-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOROS",
        "first_name": "OTTILIA",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "CNP241459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.