NPIMap

Individual provider Active NPI

Marianne Rosenwald Boschen, PA-C

  • Medical Physician Assistant
  • Jackson, WY
National Provider Identifier
1851476402
Registry record updated Aug 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
301 Issued in WY
Practice address
555 E Broadway Ave
Jackson, WY 83001-8640
Phone
(307) 733-3900
NPI assigned
Oct 25, 2006
Last updated
Aug 12, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 301 WY Primary

Addresses

Primary practice location

555 E Broadway Ave
Jackson, WY 83001-8640

Mailing address

555 E Broadway Ave
Jackson, WY 83001-8640
Phone (307) 733-3900

Other identifiers 1

IdentifierTypeStateIssuer
113974600MedicaidWY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20231229002232 UT Practitioner - Physician Assistant 6204884513 Reassigns benefits to 1 organization
I20250716004144 TX Practitioner - Physician Assistant 6204884513 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Utah School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DHHS PHS Naihs Shiprock HospitalGroup PAC ID 0749193837, 148 clinicians

Practice addresses (Care Compare)

Highway 491
Shiprock, NM 87420-0160
Phone 50536860016401

P O Box
160 Attn Business Office
Shiprock, NM 87420-0160

PO Box
Suite 160
Shiprock, NM 87420-0160

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Moab Valley Healthcare, Inc. CurrentSince Nov 14, 2023 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jun 30, 2025 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jun 30, 2025 Accepting new patients
Urgent Care of Jackson Hole, LLC Past Accepting new patients
Snake River Orthopedics PC Past Accepting new patients
Jackson Hole Medical Clinic, LLC Past Accepting new patients
Moab Valley Healthcare Inc Past Accepting new patients

Locations

450 W Williams Way
Moab, UT 84532
Phone (435) 259-7191

Interoperability endpoints

  • Direct secure messaging: marianne.boschen.p1@direct.tetonortho.nextgenshare.com

Organizations & group practices 8

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 7

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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1851476402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-733-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-733-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSCHEN",
        "first_name": "MARIANNE",
        "middle_name": "ROSENWALD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WY",
            "license": "301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113974600",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, WY

Sources for this page

Verify at the official NPI Registry.