Nicole Bottino, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

25MP00383500 Issued in NJ

Practice address

319 Longwood Ave
Boston, MA 02115

Phone

(617) 355-3501

Fax

(617) 730-0682

NPI assigned

Jul 26, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: nicole.bottino@ppos.directbygreenway.com

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.

• Practice Associates Medical Group

  • Internal Medicine Physician
  • Morristown, NJ
  • NPI 1427016385
  Medicare reassignment

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

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1982950002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 FAIRFAX CT",
            "city": "MADISON",
            "state": "NJ",
            "postal_code": "079401150",
            "telephone_number": "201-739-2402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02115",
            "telephone_number": "617-355-3501",
            "fax_number": "617-730-0682"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "319 Longwood Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021155728",
            "country_code": "US",
            "telephone_number": "617-355-3501",
            "fax_number": "617-730-0682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOTTINO",
        "first_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-26",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MA",
            "license": "PA4441",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00383500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Botteas, MA, LMHC
• Stephan Bottex, CNP
• Kelly Elizabeth Bottger, FNP
• Brittany Botticelli, MD
• Clement J Bottino, M.D., M.P.H
• Maurizio Angelo Maria Bottiroli
• Samantha Fay Bottom-Tanzer, MD/PHD
• Susan Botzko
• Mark Bou Chaaya
• Chilan Bou Ghosson Leite, MD

• Surgical Physician Assistant in Boston, MA
• Providers in Boston, MA by specialty
• Surgical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; 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.