Active NPI
Ilyssa Bozza
- Clinical Social Worker
- Albuquerque, NM
National Provider Identifier
1952886277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SWB-2023-0067
- Practice address
- 10052 Coors Blvd NW
Albuquerque, NM 87114-4020 - Phone
- (505) 459-0025
- Fax
- (505) 899-8372
- NPI assigned
- Oct 2, 2018
- Last updated
- Aug 1, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SWB-2023-0067 | NM | Primary |
| Case Manager/Care Coordinator | 171M00000X | NU |
Addresses
Primary practice location
10052 Coors Blvd NW
Albuquerque, NM 87114-4020
Mailing address
12276 Highway 14 N
Cedar Crest, NM 87008-9400
Phone (505) 730-3644
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51355361 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SWB-2023-0067 | NM | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grace Integrated Solutions, LLC | Current | Accepting new patients |
Locations
5800 McLeod Rd NE
Ste F
Albuquerque, NM 87109
Phone (505) 363-0250
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Albuquerque, NM
- NPI 1477208015
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690848000000",
"number": "1952886277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12276 HIGHWAY 14 N",
"city": "CEDAR CREST",
"state": "NM",
"postal_code": "870089400",
"telephone_number": "505-730-3644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10052 COORS BLVD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871144020",
"telephone_number": "505-459-0025",
"fax_number": "505-899-8372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOZZA",
"first_name": "ILYSSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-02",
"last_updated": "2023-08-01",
"certification_date": "2023-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "SWB-2023-0067",
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "51355361",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.