Gerry Boccarossa, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DO 1162 Issued in TN

Practice address

412 Mountain View CT
Blountville, TN 37617-6252

Phone

(423) 220-0650

NPI assigned

Jun 9, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

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 Osteopathy

State licenses

Practice roles

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.

• Wellmont Physician Services Inc

  • Internal Medicine Physician
  • Big Stone Gap, VA
  • NPI 1619095403

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314921600000",
    "number": "1912901760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 MOUNTAIN VIEW CT",
            "city": "BLOUNTVILLE",
            "state": "TN",
            "postal_code": "376176252",
            "telephone_number": "423-220-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 MOUNTAIN VIEW CT",
            "city": "BLOUNTVILLE",
            "state": "TN",
            "postal_code": "376176252",
            "telephone_number": "423-220-0650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCCAROSSA",
        "first_name": "GERRY",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2011-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "DO 1162",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102201244",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3304613",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005830494",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Codie Berry, RN
• Bronson Lee Best, MA, CCC-SLP
• Vivian K Bishop, RN
• Blounts Operator LLC
• Blountville Drug Company Inc.
• Ashley Brooke Booher, APRN
• Katerina A Borsch, PT
• Amanda C Bowers, PHARMD
• Mark A Bowers
• Jeannie Odelia Bowman, RN

• All providers in Blountville, TN
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; 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.