Individual provider Active NPI

Bowlva Michael Lee, D.O.

  • Pain Medicine (Anesthesiology) Physician
  • Dallas, TX
National Provider Identifier
1053631259
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
P2477 Issued in TX
Practice address
9441 LBJ Fwy Suite 114
Dallas, TX 75243-4635
Phone
(214) 557-4111
Fax
(972) 972-8660
NPI assigned
Jun 10, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X P2477 TX Primary

Addresses

Primary practice location

9441 LBJ Fwy Suite 114
Dallas, TX 75243-4635

Mailing address

720 Highway 377, Suite 140, PMB 155
Roanoke, TX 76262-6893
Phone (347) 560-1640

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170630000696 TX Practitioner - Pain Management 9133385065 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
P2477TXMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hudson Anesthesia Services, P.C. Pain Medicine CurrentSince Jul 4, 2012 Accepting new patients

Locations

160 7th Ave S
New York, NY 10014
Phone (212) 206-1501

350 Broadway
Rm 200
New York, NY 10013
Phone (646) 596-7386

281 Broadway
Fl 2
New York, NY 10007
Phone (646) 596-7386

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1053631259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 HIGHWAY 377, SUITE 140, PMB 155",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762626893",
            "telephone_number": "347-560-1640",
            "fax_number": "972-972-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9441 LBJ FWY SUITE 114",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752434635",
            "telephone_number": "214-557-4111",
            "fax_number": "972-972-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "BOWLVA",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-10",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "TX",
            "license": "P2477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.