Debarati Banerji Bose, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036117495 Issued in IL

Practice address

6701 US Highway 34
Oswego, IL 60543-9129

Phone

(630) 646-4255

Fax

(630) 646-4256

NPI assigned

Apr 25, 2007

Last updated

Mar 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL

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 Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dbose14757@direct.edward.org

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.

• Edward Health Ventures

  • Multi-Specialty Clinic/Center
  • Bolingbrook, IL
  • NPI 1962452912
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  IL

  Medicare reassignment NPD
• Edward Health Ventures

  dba Edward Medical Group Weight Loss Clinic

  • Internal Medicine Physician
  • Naperville, IL
  • NPI 1760819650
  NPD
• Edward Health Ventures

  dba Edward Medical Group

  • Internal Medicine Physician
  • Naperville, IL
  • NPI 1790735744
  NPD (past)

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1982823100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 US HIGHWAY 34",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605439129",
            "telephone_number": "630-646-4255",
            "fax_number": "630-646-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 US HIGHWAY 34",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605439129",
            "telephone_number": "630-646-4255",
            "fax_number": "630-646-4256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSE",
        "first_name": "DEBARATI",
        "middle_name": "BANERJI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036117495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19828231001",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dbose14757@direct.edward.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "6701 US Highway 34",
            "city": "Oswego",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605439129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dbose14757@direct.edward.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "6701 US Highway 34",
            "city": "Oswego",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605439129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Margaret Elizabeth Bollinger
• Michaela Bolosan
• Daniel L Borner Sr.
• Kathleen Boron, PTA
• Jennifer Borrowman
• Vincent Botta, A.P.N.
• Melanie Daniela Bourgoine, LSW
• Lindsay Brady
• Elizabeth Lassandrello Bremner
• Valerie Bremner, RN

• Family Medicine Physician in Oswego, IL
• Providers in Oswego, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; 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.