NPIMap

Organization Active NPI

Bolivar Physician Practices LLC

Doing business as Bolivar Orthopedics

  • Orthopaedic Surgery Physician
  • Cleveland, MS
National Provider Identifier
1063659530
Registry record updated Jun 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
BOLIVAR PHYSICIAN PRACTICES LLC
Doing business as
Bolivar Orthopedics
Practice address
907 E Sunflower Rd
Suite 102
Cleveland, MS 38732-2830
Phone
(662) 843-8885
Fax
(662) 843-2280
NPI assigned
Jan 20, 2009
Last updated
Jun 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2026

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X Primary

Addresses

Primary practice location

907 E Sunflower Rd
Suite 102
Cleveland, MS 38732-2830

Mailing address

907 E Sunflower Rd Ste 102
Cleveland, MS 38732-2830
Phone (662) 843-8885

Other names 1

  • Bolivar Orthopedics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090512000274 MS Part B Supplier - Clinic/Group Practice 6305995895 Receives reassigned benefits from 42 practitioners
6 other NPIs on this enrollment
Practice locations: Cleveland, MS; Rosedale, MS

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bolivar Physician Practices7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1003 W Sunflower Rd
Cleveland, MS 38733
Phone (479) 459-1507

810 E Sunflower Rd
Cleveland, MS 38732
Phone (662) 579-3484

907 E Sunflower Rd
Ste 102
Cleveland, MS 38732
Phone (662) 545-4443

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1232409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780531200000",
    "number": "1063659530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 E SUNFLOWER RD STE 102",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322830",
            "telephone_number": "662-843-8885",
            "fax_number": "662-843-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 E SUNFLOWER RD",
            "address_2": "SUITE 102",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322830",
            "telephone_number": "662-843-8885",
            "fax_number": "662-843-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLIVAR PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-20",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolivar Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.