NPIMap

Individual provider Active NPI

John Leon Bossian II, DO

  • Family Medicine Physician
  • Pearl Harbor, HI
National Provider Identifier
1881651271
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO1419 Issued in HI
Practice address
15TH Mdos JBPH
Circle Road
Pearl Harbor, HI 96734
Phone
(808) 448-6100
NPI assigned
Apr 28, 2006
Last updated
Jul 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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 DO1419 HI Primary

Addresses

Primary practice location

15TH Mdos JBPH
Circle Road
Pearl Harbor, HI 96734

Mailing address

515 Iliaina St
Kailua, HI 96734-1812
Phone (808) 448-6100

Other identifiers 3

IdentifierTypeStateIssuer
5820708MedicaidRI
JB35286MedicaidRI
MS46923OtherRIWELFARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200408002916 HI Practitioner - Family Practice 7810055472 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Straub Clinic and HospitalGroup PAC ID 6305759754, 420 clinicians

Practice addresses (Care Compare)

888 S King St
Honolulu, HI 96813-3097
Phone (808) 522-4000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO1419HIMDFamily Medicine Physician
00391RIMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Straub Clinic & Hospital CurrentSince Apr 6, 2020 Accepting new patients
Straub Clinic & Hospital Single Specialty CurrentSince Apr 6, 2020 Accepting new patients
Straub Clinic & Hospital Past Accepting new patients
John L Bossian Single Specialty PastSince Jan 1, 1990 Accepting new patients

Locations

888 S King St
Honolulu, HI 96813
Phone (808) 522-4000

602 Kailua Rd
Ste 200
Kailua, HI 96734
Phone (808) 263-9100

Organizations & group practices 4

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 8

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": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531785600000",
    "number": "1881651271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 ILIAINA ST",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967341812",
            "telephone_number": "808-448-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15TH MDOS JBPH",
            "address_2": "CIRCLE ROAD",
            "city": "PEARL HARBOR",
            "state": "HI",
            "postal_code": "96734",
            "telephone_number": "808-448-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSSIAN",
        "first_name": "JOHN",
        "middle_name": "LEON",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2018-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "DO1419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5820708",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "JB35286",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELFARE",
            "identifier": "MS46923",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pearl Harbor, HI

Sources for this page

Verify at the official NPI Registry.