Mayra Bolden, (FNP) FAMILY NURSE P
Individual provider Active NPI Family Nurse Practitioner · Melrose, MA
NPI 1073074464 · NPPES record last updated Sep 8, 2020
Key facts
- NPI
- 1073074464
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN2280131 (MA)
- Practice address
- 585 Lebanon St
Melrose, MA 02176 - Phone
- (781) 979-3000
- NPI assigned
- Mar 27, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Massachusetts Acute Care Specialists PC
Practice addresses (Care Compare)
585 Lebanon St
Melrose, MA 02176-3225
Phone (781) 979-3000
Hospital & facility affiliations
- Melrosewakefield Healthcare
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201014003699 | MA | Practitioner - Nurse Practitioner | 4082034996 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN2280131 | MA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Massachusetts Acute Care Specialists PC | Current |
Accepting new patients | |
| 360 Healthcare LLC | Current |
Accepting new patients | |
| Melrosewakefield Healthcare, Inc. | Past | Accepting new patients |
Locations
10 Mall Rd
Ste 305
Burlington, MA 01803
170 Governors Ave
Medford, MA 02155
Phone (781) 306-6000
585 Lebanon St
Melrose, MA 02176
Phone (781) 979-3026
750 Woburn St
Wilmington, MA 01887
Phone (781) 488-6843
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical-Surgical Registered Nurse | 163WM0705X | RN2280131 | MA | |
| Family Nurse Practitioner | 363LF0000X | RN2280131 | MA | Yes |
Addresses
Primary practice location
585 Lebanon St
Melrose, MA 02176
Mailing address
585 Lebanon St
Melrose, MA 02176
Phone (781) 979-3000
Other providers in Melrose, MA
- Marcia M. Binder
- Samantha Block
- Sarah Bloom
- Julie Ann Blume Oeur
- Gregory Bodine
- Katrina Daigle Borden
- Ilana Bortinger
- Boston Pain Specialist, PC
- Boston Pelvic Physical Therapy
- Shannon Bottari
All providers in Melrose, MA · Family Nurse Practitioner in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.