Edward De Jesus Bolanos, CAA

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

AA97 Issued in FL

Practice address

1901 SW 172ND Ave
Miramar, FL 33029-5592

Phone

(954) 838-2371

Fax

(954) 851-1746

NPI assigned

Sep 15, 2011

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Anesthesiology Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sheridan Healthcorp IncGroup PAC ID 3173429693, 956 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital Miramar Hospital, Miramar, FL, CCN 100285

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts

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.

• Sheridan Healthcorp Inc

  • Anesthesiology Physician
  • Okeechobee, FL
  • NPI 1629781711
  Medicare reassignment Care Compare group NPD
• Sheridan Healthcorp Inc

  • Anesthesiology Physician
  • Ft Lauderdale, FL
  • NPI 1821071960
  NPD
• Sheridan Healthcorp, Inc.

  • Anesthesiology Physician
  • North Miami Beach, FL
  • NPI 1578429460
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• South Broward Hospital District

  • General Acute Care Hospital
  • Miramar, FL
  • NPI 1326021197
  Care Compare affiliation

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1073895017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 W SUNRISE BLVD",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333224113",
            "telephone_number": "954-838-2371",
            "fax_number": "954-851-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 SW 172ND AVE",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330295592",
            "telephone_number": "954-838-2371",
            "fax_number": "954-851-1746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLANOS",
        "first_name": "EDWARD",
        "middle_name": "DE JESUS",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-15",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "FL",
            "license": "AA97",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebolanos78380@mhsdirect.net",
            "affiliation": "N",
            "address_1": "1901 SW 172nd Ave",
            "city": "Miramar",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330295592",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Anesthesiologist Assistant in Miramar, FL
• Providers in Miramar, FL by specialty
• Anesthesiologist Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.