KELLEN BOSMA D.M.D.
NPI 1407288830
Dentist in Litchfield, IL

Q: What is Kellen Bosma's NPI number?

The NPI number for Kellen Bosma is 1407288830. It was assigned to this individual provider in the NPPES registry on August 8, 2013.

Q: What is Kellen Bosma's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: Is Kellen Bosma enrolled in Medicare?

No. Kellen Bosma has opted out of Medicare through April 19, 2028. 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.

Q: When was this NPI record last updated?

The NPPES record for Kellen Bosma was last updated on August 8, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years 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.

Active since August 08, 2013Opted out of Medicare · through Apr 19, 2028

125 W COLUMBIAN BLVD S, LITCHFIELD, IL 62056(217) 324-2610 Get Directions Write a Review

NPPES record last updated: August 8, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Kellen Bosma D.m.d. NPPES

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

KELLEN BOSMA D.M.D. (NPI 1407288830) is an individual dentist in Litchfield, Illinois, licensed in Illinois (019.029540) and active in the NPI registry since August 2013. He has opted out of Medicare through April 19, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1407288830

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameKELLEN BOSMACredential: D.M.D.

Location Address125 W COLUMBIAN BLVD SLitchfield, IL 62056-3021

Mailing Address125 W Columbian Blvd SLitchfield, IL 62056-3021 · (217) 324-2610

Phone(217) 324-2610

Sole ProprietorNo

Enumeration DateAugust 8, 2013

✔ NPI 1407288830 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in IL · 019.029540

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

125 W COLUMBIAN BLVD S, Litchfield, IL 62056

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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

Kellen Bosma D.m.d. 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 April 19, 2016 through April 19, 2028.

Opt-Out Effective DateApril 19, 2016

Opt-Out In Effect ThroughApril 19, 2028Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62056 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.44 typical visit price

range $56.28 – $173.35

Typical copayment $22.11 (range $14.07 – $43.33)

Most-billed visit code 99203

Established Patient

$70.42 typical visit price

range $17.51 – $139.99

Typical copayment $17.60 (range $4.37 – $34.99)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARISSA HARRELL RDH, PHDH

Dental Hygienist