Jon P Boettger, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9105512 Issued in FL

Practice address

12902 Usf Magnolia Dr
Tampa, FL 33612-9416

Phone

(813) 745-4673

NPI assigned

Jul 8, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

H Lee Moffitt Cancer Ctr and Res Inst Life Time Cancer SCRN Ctr IncGroup PAC ID 2264337021, 1,145 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• H Lee Moffitt Cancer Center & Research Institute I Hospital, Tampa, FL, CCN 100271

Merit-based Incentive Payment System (MIPS)

Final score

88 of 100Reported as group

Quality

74.04

Promoting interoperability

100

Improvement activities

40

Cost

70.96

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer SCRN Ctr Inc

  • Hematology & Oncology Physician
  • Tampa, FL
  • NPI 1306833595

  FL

  Medicare reassignment Care Compare group
• Pioneer Medical Group, PL

  • Internal Medicine Physician
  • Temple Terrace, FL
  • NPI 1710315775

  FL

  Medicare reassignment
• Space Coast Emergency Physicians PLC

  • Emergency Medicine Physician
  • Cocoa Beach, FL
  • NPI 1508851569
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc.

  • Special Hospital
  • Tampa, FL
  • NPI 1780653618

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1982916888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198441",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303848441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12902 USF MAGNOLIA DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336129416",
            "telephone_number": "813-745-4673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6001 Kyle Pkwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "Kyle",
            "state": "TX",
            "postal_code": "78640",
            "country_code": "US",
            "telephone_number": "512-294-1771",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4450 Sojourn Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Addison",
            "state": "TX",
            "postal_code": "75001",
            "country_code": "US",
            "telephone_number": "972-733-0014",
            "fax_number": "972-733-0125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOETTGER",
        "first_name": "JON",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-08",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12179",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "391145503",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jon.boettger@direct.moffitt.org",
            "affiliation": "N",
            "address_1": "12902 Usf Magnolia Dr",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336129416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Eric Michael Boe, DMD
• Sydney Rae Boehnlein, MS, RD, LD, CSSD
• Samantha Bogard, DO
• Caitlyn Mackenzie Bogart, OTR/L
• Delia Bogert
• Shelley E. Boggan, LCSW
• Raul R. Boggio, M. D.

• All providers in Tampa, FL
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.