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MS. KATHERINE LOUISE BODER PA-C
NPI 1174711816
Physician Assistant in Greenlawn, NY

Active since October 09, 2007Opted out of Medicare · through Nov 5, 2027
112 DARROW LN, GREENLAWN, NY 11740(917) 545-9061 Get Directions Write a Review

NPPES record last updated: July 12, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Ms. Katherine Louise Boder Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. KATHERINE LOUISE BODER PA-C (NPI 1174711816) is an individual physician assistant in Greenlawn, New York, licensed in New York (008885) and active in the NPI registry since October 2007. She has opted out of Medicare through November 5, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1174711816
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMS. KATHERINE LOUISE BODERCredential: PA-C
Location Address112 DARROW LNGreenlawn, NY 11740-2907
Mailing Address112 Darrow LnGreenlawn, NY 11740-2907 · (917) 545-9061
Phone(917) 545-9061
Sole ProprietorNo
Enumeration DateOctober 9, 2007
Last NPPES UpdateJuly 12, 2025
NPPES CertifiedJuly 12, 2025
✔ NPI 1174711816 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NY · 008885
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
112 DARROW LN, Greenlawn, NY 11740
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Ms. Katherine Louise Boder Pa-c has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from November 5, 2025 through November 5, 2027.

Opt-Out Effective DateNovember 5, 2025
Opt-Out In Effect ThroughNovember 5, 2027Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Katherine Boder's NPI number?

The NPI number for Katherine Boder is 1174711816. It was assigned to this individual provider in the NPPES registry on October 9, 2007.

Where is Katherine Boder located?

Katherine Boder practices at 112 Darrow Ln, Greenlawn, NY 11740. The listed phone number is (917) 545-9061.

What is Katherine Boder's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Katherine Boder enrolled in Medicare?

No. Katherine Boder has opted out of Medicare through November 5, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Katherine Boder was last updated on July 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.