Active NPI
Rebecca Suzanne Bohl, PA-C
- Physician Assistant
- Fort Collins, CO
National Provider Identifier
1952653859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- COA109658
- Practice address
- 1120 E Elizabeth St Ste F101
Fort Collins, CO 80524-4044 - Phone
- (970) 584-1063
- Fax
- (970) 584-1055
- NPI assigned
- Oct 3, 2012
- Last updated
- May 2, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | COA109658 | CO | Primary |
Addresses
Primary practice location
1120 E Elizabeth St Ste F101
Fort Collins, CO 80524-4044
Mailing address
203 S Rollie Ave
Fort Lupton, CO 80621-1508
Phone (303) 286-4560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17123313 | Medicaid | CO |
Other names 1
- Rebecca Suzanne Broda
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA109658 | CO | MD | Physician Assistant |
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.
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- Fort Collins, CO
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651449600000",
"number": "1952653859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 S ROLLIE AVE",
"city": "FORT LUPTON",
"state": "CO",
"postal_code": "806211508",
"telephone_number": "303-286-4560",
"fax_number": "303-286-4589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 E ELIZABETH ST STE F101",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805244044",
"telephone_number": "970-584-1063",
"fax_number": "970-584-1055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOHL",
"first_name": "REBECCA",
"middle_name": "SUZANNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-03",
"last_updated": "2022-05-02",
"certification_date": "2022-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "COA109658",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "17123313",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "REBECCA",
"last_name": "BRODA",
"middle_name": "SUZANNE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; 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.