NPIMap

Individual provider Active NPI

B Alan Bottenberg, D.O.

  • Internal Medicine Physician
  • Carson City, NV
National Provider Identifier
1942210349
Registry record updated Nov 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DO674 Issued in NV
Practice address
550 W Washington St
Suite 1
Carson City, NV 89703-3829
Phone
(775) 883-3953
Fax
(775) 885-2785
NPI assigned
Aug 8, 2006
Last updated
Nov 28, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DO674 NV Primary

Addresses

Primary practice location

550 W Washington St
Suite 1
Carson City, NV 89703-3829

Mailing address

4095 N Carson St
Carson City, NV 89706-1936
Phone (775) 883-3953

Other identifiers 1

IdentifierTypeStateIssuer
002013067MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20040602000163 NV Practitioner - Internal Medicine 8224010699 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1761 College Pkwy
Suite 112
Carson City, NV 89706-7954
Phone (775) 400-1144

4095 N Carson St
Carson City, NV 89706-1936

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO674NVMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Servanna Health LLC Current Accepting new patients

Locations

1761 College Pkwy
Ste 112
Carson City, NV 89706
Phone (775) 477-7823

Organizations & group practices 2

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 10

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": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511827200000",
    "number": "1942210349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4095 N CARSON ST",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897061936",
            "telephone_number": "775-883-3953",
            "fax_number": "775-885-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 W WASHINGTON ST",
            "address_2": "SUITE 1",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897033829",
            "telephone_number": "775-883-3953",
            "fax_number": "775-885-2785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTENBERG",
        "first_name": "B",
        "middle_name": "ALAN",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2017-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "DO674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002013067",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carson City, NV

Sources for this page

Verify at the official NPI Registry.