Active NPI
Bo Michael Kitrell, MD
- Dermatology Physician
- San Diego, CA
National Provider Identifier
1841041548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MT233830
- Practice address
- 4077 Fifth Ave # Mer-35
San Diego, CA 92103-2105 - Phone
- (619) 260-7220
- NPI assigned
- Mar 29, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MT233830 | PA | Primary |
Addresses
Primary practice location
4077 Fifth Ave # Mer-35
San Diego, CA 92103-2105
Mailing address
16 Woodbine LN
Danville, PA 17821-8029
Phone (570) 271-8050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250611001125 | PA | Order and Referring Only - Dermatology | 5496265134 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT233830 | PA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752451200000",
"number": "1841041548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 WOODBINE LN",
"city": "DANVILLE",
"state": "PA",
"postal_code": "178218029",
"telephone_number": "570-271-8050",
"fax_number": "570-271-5940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4077 FIFTH AVE # MER-35",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032105",
"telephone_number": "619-260-7220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KITRELL",
"first_name": "BO",
"middle_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-29",
"last_updated": "2025-07-14",
"certification_date": "2025-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "PA",
"license": "MT233830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.