NPIMap

Individual provider Active NPI

Lynn A Bolenbaugh, PA-C

  • Physician Assistant
  • Amherst, OH
National Provider Identifier
1013131721
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.001726RX Issued in OH
Practice address
578 N Leavitt Rd
Amherst, OH 44001-1131
Phone
(440) 989-3801
Fax
(440) 960-0264
NPI assigned
Apr 12, 2007
Last updated
Sep 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.001726RX OH Primary

Addresses

Primary practice location

578 N Leavitt Rd
Amherst, OH 44001-1131

Mailing address

PO Box 636643
Cincinnati, OH 45263-6643
Phone (440) 989-3801

Other identifiers 1

IdentifierTypeStateIssuer
3025372MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120719000502 OH Practitioner - Physician Assistant 9335305382 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospital Care Group PCGroup PAC ID 7416107487, 29 clinicians

Practice addresses (Care Compare)

1600 E Riverview
Napoleon, OH 43545-9399
Phone (260) 344-3045

800 W Main St
Coldwater, OH 45828-1613
Phone (260) 344-4035

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic Pathology, LLC Current Accepting new patients
Mercer County Joint Township Community Hospital CurrentSince Sep 1, 2023 Accepting new patients
Mercer County Joint Township Community Hospital CurrentSince Sep 1, 2023 Accepting new patients
University Hospitals Cleveland Medical Center CurrentSince Oct 1, 2017 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

11100 Euclid Ave
Cleveland Heights, OH 44106

800 W Main St
Coldwater, OH 45828
Phone (419) 678-2341

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1013131721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636643",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636643",
            "telephone_number": "440-989-3801",
            "fax_number": "440-960-0264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "578 N LEAVITT RD",
            "city": "AMHERST",
            "state": "OH",
            "postal_code": "440011131",
            "telephone_number": "440-989-3801",
            "fax_number": "440-960-0264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLENBAUGH",
        "first_name": "LYNN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.001726RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3025372",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amherst, OH

Sources for this page

Verify at the official NPI Registry.