Individual provider Active NPI

Kodjo Martial Bossou, MD

  • Public Health & General Preventive Medicine Physician
  • Rochester, MN
National Provider Identifier
1982823951
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
License
51060 Issued in MN
Practice address
200 1St St SW
Rochester, MN 55905-0001
Phone
(651) 267-5000
NPI assigned
Apr 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 51060 MN
Public Health & General Preventive Medicine Physician 2083P0901X 51060 MN Primary

Addresses

Primary practice location

200 1St St SW
Rochester, MN 55905-0001

Mailing address

200 1St St SW
Rochester, MN 55905-0001
Phone (651) 267-5000

Other practice location 1

701 Hewitt Blvd
Red Wing, MN 55066-2848
Phone (651) 267-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kbossou67870@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20081028000065 MN Practitioner - Preventive MedicinePractitioner - Family Practice 9032277579 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Preventive MedicineAlso: Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo ClinicGroup PAC ID 6507778255, 4,829 clinicians

Practice addresses (Care Compare)

200 1St St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic CurrentSince Aug 28, 2024 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince May 28, 2015 Accepting new patients
Mayo Clinic Current Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince May 28, 2015 Accepting new patients
Mayo Clinic CurrentSince Aug 28, 2024 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Apr 1, 2019 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Apr 1, 2019 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

301 2nd St NE
New Prague, MN 56071
Phone (952) 758-4431

701 Hewitt Blvd
Red Wing, MN 55066
Phone (507) 377-6285

1650 4th St SE
Rochester, MN 55904
Phone (507) 285-8485

210 9th St SE
Rochester, MN 55904
Phone (507) 529-6616

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531

Interoperability endpoints

  • Direct secure messaging: kbossou67870@ehrdirect.mayoclinicmsg.org

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1982823951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "651-267-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "651-267-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Hewitt Blvd",
            "address_purpose": "LOCATION",
            "city": "Red Wing",
            "state": "MN",
            "postal_code": "550662848",
            "country_code": "US",
            "telephone_number": "651-267-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSSOU",
        "first_name": "KODJO",
        "middle_name": "MARTIAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "51060",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "MN",
            "license": "51060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbossou67870@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "200 1st St SW",
            "city": "Rochester",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559050001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.