Alan Bartholomew, D.O.
Individual provider Active NPI Rheumatology Physician · Keesler Afb, MS
NPI 1003296153 · NPPES record last updated Aug 13, 2020
Key facts
- NPI
- 1003296153
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Rheumatology Physician 207RR0500X
- License
- 1747 (NE)
- Practice address
- 301 Fisher St RM 1F325
Keesler Afb, MS 39534-2508 - Phone
- (801) 706-4520
- NPI assigned
- Jun 4, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160901001147 | MS | Order and Referring Only - Internal Medicine |
1254627185 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1747 | NE | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | 1747 | NE | |
| Rheumatology Physician | 207RR0500X | 1747 | NE | Yes |
Addresses
Primary practice location
301 Fisher St RM 1F325
Keesler Afb, MS 39534-2508
Mailing address
88 MDG/SGHJ
4881 Sugar Maple Dr.
Wright Patterson Afb, OH 45433
Phone (937) 257-6529
Other practice location 1
88 MDG/SGHJ 4881 Sugar Maple Dr.
Wright Patterson AFB, OH 45433
Phone (937) 522-2778
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1747 | Medicaid | NE |
Other providers in Keesler Afb, MS
- Nicolas Cheatham Appleton
- Melinda Marie Auxier
- Erika Balazs
- Matthew Frederick Barchie
- Kiono Lance Barnes
- Alexis Anthon Beauvais
- Jared Bell
- Candee Berck
- Angelia Ruth Bone
- Sarah K Bowen
All providers in Keesler Afb, MS · Rheumatology Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.