HALEY MARLENE BOGDANOVICH (PA-C) – Physician Assistant, NPI 1891285995
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
10,570 PHYSICIAN ASSISTANT in CA
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Provider Addresses for HALEY MARLENE BOGDANOVICH (PA-C)
309, East 2nd Street, Edison Historic District, Pomona, Los Angeles County, California, 91766, United States
POMONA, CA 917661854
Phone: (909) 623-6116
Type: Location
33494, Oak Glen Road, Yucaipa, San Bernardino County, California, 92399, United States
YUCAIPA, CA 923992057
Phone: (097) 978-9009
Type: Mailing
637 MAPLE AVE
LOS ANGELES, CA 900142211
Phone: (213) 434-8990
Type: Location
1 EMBARCADERO CTR STE 1900
SAN FRANCISCO, CA 941113723
Phone:
Type: Mailing
2 EMBARCADERO CTR
SAN FRANCISCO, CA 941113823
Phone: (888) 663-6331
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-07-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190712001043 | I | Physician Assistant | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 91766)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | CA | |
| - | CA | |
| Nurse Practitioner | GA | |
| Nurse Practitioner | FL | |
| Physician Assistant | CA | |
| - | CA | |
| Physician Assistant | CA | |
| - | CA | |
| Physician Assistant | CA | |
| Physician Assistant | CA |
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