NPIMap

Individual provider Active NPI

Praveen K Bolarum, M.D.

  • Family Medicine Physician
  • Frederick, MD
National Provider Identifier
1073575015
Registry record updated Jun 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0062223 Issued in MD
Practice address
196 Thomas Johnson Dr Ste 135
Frederick, MD 21702
Phone
(301) 694-6688
Fax
(301) 694-8524
NPI assigned
Apr 5, 2006
Last updated
Jun 12, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X D0062223 MD Primary

Addresses

Primary practice location

196 Thomas Johnson Dr Ste 135
Frederick, MD 21702

Mailing address

196 Thomas Johnson Dr Ste 135
Frederick, MD 21702-4518
Phone (301) 694-6688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041222000632 MD Practitioner - Family PracticePractitioner - Hospitalist 0648238600 Reassigns benefits to 3 organizations
I20101116000923 DC Practitioner - Family Practice 0648238600 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Praveen Bolarum MD LLCGroup PAC ID 9638276199, 5 clinicians
Amber Hill Physical Therapy IncGroup PAC ID 8527963917, 336 clinicians
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

10714 Potomac Tennis LN
Potomac, MD 20854-4418
Phone (301) 299-2273

187 Thomas Johnson Dr
Frederick, MD 21702-4503

196 Thomas Johnson Dr
Frederick, MD 21702-4518
Phone (301) 694-6688

3001 S Hanover St
Baltimore, MD 21225-1233
Phone (410) 350-3200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40
Cost
86.08

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Dec 1, 2021 Accepting new patients
Medstar Medical Group II LLC CurrentSince Dec 1, 2021 Accepting new patients
Upper Chesapeake Medical Services, Inc CurrentSince Jan 21, 2023 Accepting new patients
Praveen Bolarum, MD LLC CurrentSince Nov 1, 2006 Accepting new patients
Creekside SNF Operating Company LLC Past Accepting new patients
347 Ballenger Opco LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Homewood Living Williamsport, Inc. Past Accepting new patients

Locations

201 E University Pkwy
Baltimore, MD 21218
Phone (410) 554-2651

5601 Loch Raven Blvd
Baltimore, MD 21239
Phone (443) 444-4714

500 Upper Chesapeake Dr
Bel Air, MD 21014
Phone (443) 643-1000

6530 Democracy Blvd
Bethesda, MD 20817
Phone (301) 530-9000

3001 S Hanover St
Brooklyn Park, MD 21225
Phone (410) 350-3200

23310 Frederick Rd
Clarksburg, MD 20871
Phone (240) 219-6686

196 Thomas Johnson Dr
Ste 135
Frederick, MD 21702
Phone (301) 200-5639

400 W 7th St
Frederick, MD 21701
Phone (240) 566-3300

1406 Crain Hwy S
Glen Burnie, MD 21061
Phone (410) 768-6440

10714 Potomac Tennis Ln
Potomac, MD 20854
Phone (301) 299-2273

9000 Franklin Square Dr
Rosedale, MD 21237
Phone (410) 682-7000

3390 Urbana Pike
Urbana, MD 21704
Phone (240) 893-8944

Organizations & group practices 11

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 10

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": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1073575015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 THOMAS JOHNSON DR STE 135",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024518",
            "telephone_number": "301-694-6688",
            "fax_number": "301-694-8524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 THOMAS JOHNSON DR STE 135",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "21702",
            "telephone_number": "301-694-6688",
            "fax_number": "301-694-8524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLARUM",
        "first_name": "PRAVEEN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0062223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

Verify at the official NPI Registry.