Bryan L Bolwahnn, PHD, M.P.

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

926MPAP Issued in LA

Practice address

100 Gayven Dr
Ball, LA 71405-4903

Phone

(318) 641-0444

Fax

(318) 641-6118

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Administrators of the Tulane Educational FundGroup PAC ID 0446163760, 388 clinicians

Rapides Primary Health Care Center, IncorporatedGroup PAC ID 3779570973, 6 clinicians

Central la Human Services DistrictGroup PAC ID 7618105529, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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

• Administrators of the Tulane Educational Fund

  • Specialist
  • Covington, LA
  • NPI 1245434224

  LA

  Medicare reassignment Care Compare group NPD
• Central la Human Services District

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alexandria, LA
  • NPI 1033543756

  LA

  Medicare reassignment Care Compare group NPD
• Rapides Primary Health Care Center, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Alexandria, LA
  • NPI 1568404838

  LA

  Medicare reassignment Care Compare group
• Administrators of the Tulane Educational Fund

  • Specialist
  • New Orleans, LA
  • NPI 1528014164
  Care Compare group
• Administrators of the Tulane Educational Fund

  • Clinical Medical Laboratory
  • New Orleans, LA
  • NPI 1679715098
  Care Compare group
• Central la Human Services District

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Leesville, LA
  • NPI 1295169886
  NPD
• Central la Human Services District

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Marksville, LA
  • NPI 1740614338
  NPD
• Administrators of the Tulane Educational Fund

  • Specialist
  • Hattiesburg, MS
  • NPI 1033395298
  NPD
• Louisiana Autism Center

  • Psychologist
  • Ball, LA
  • NPI 1447521455
  NPD (past)
• Zachary Psychology Center, Inc.

  • Clinical Psychologist
  • Zachary, LA
  • NPI 1538229836
  NPD (past)

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381276800000",
    "number": "1043247331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GAYVEN DR",
            "city": "BALL",
            "state": "LA",
            "postal_code": "714054903",
            "telephone_number": "318-641-0444",
            "fax_number": "318-641-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GAYVEN DR",
            "city": "BALL",
            "state": "LA",
            "postal_code": "714054903",
            "telephone_number": "318-641-0444",
            "fax_number": "318-641-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLWAHNN",
        "first_name": "BRYAN",
        "middle_name": "L",
        "credential": "PHD, M.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2013-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "LA",
            "license": "926MPAP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Access Health Louisiana
• Access Health Louisiana
• Alternative Concept Care Transportation LLC
• Kathy R. Blackman, L.C.S.W.
• Kristin Stroud Bordelon
• Bethany Branim, LCSW-BACS
• Courtney Nicole Brumley
• C & J Therapy, LLC
• Colwell Interest, Inc.

• All providers in Ball, LA
• Prescribing (Medical) Psychologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.