Individual provider Active NPI

Gabriel Alejandro Bolanos Guzman, MD

  • Gastroenterology Physician
  • Mobile, AL
National Provider Identifier
1114403292
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD.43518 Issued in AL
Practice address
1700 Spring Hill Ave Ste 100
Mobile, AL 36604-1416
Phone
(251) 435-1200
NPI assigned
Jul 12, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD.43518 AL Primary

Addresses

Primary practice location

1700 Spring Hill Ave Ste 100
Mobile, AL 36604-1416

Mailing address

1700 Spring Hill Ave Ste 100
Mobile, AL 36604-1416
Phone (251) 435-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20240813002243 AL Practitioner - Internal Medicine 5395089510 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imc-Diagnostic and Medical Clinic LLCGroup PAC ID 2860399623, 168 clinicians

Practice addresses (Care Compare)

1700 Springhill Ave
Suite 100
Mobile, AL 36604-1416
Phone (251) 435-1200

Hospital & facility affiliations

  • Mobile Infirmary Medical Center Hospital, Mobile, AL, CCN 010113
  • North Baldwin Infirmary Hospital, Bay Minette, AL, CCN 010129

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy101
Upper gastrointestinal (GI) endoscopy for acid reflux155

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.43518ALMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imc-Diagnostic and Medical Clinic LLC CurrentSince Aug 1, 2024 Accepting new patients
Imc-Diagnostic and Medical Clinic LLC Gastroenterology CurrentSince Aug 1, 2024 Accepting new patients

Locations

1725 Spring Hill Ave
Mobile, AL 36604
Phone (251) 435-1366

1700 Spring Hill Ave
Ste 100
Mobile, AL 36604

Interoperability endpoints

  • Direct secure messaging: gguzman115486@directinfirmaryhealth.org

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.

Hospital & facility affiliations 4

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": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1114403292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 SPRING HILL AVE STE 100",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366041416",
            "telephone_number": "251-435-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 SPRING HILL AVE STE 100",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366041416",
            "telephone_number": "251-435-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLANOS GUZMAN",
        "first_name": "GABRIEL",
        "middle_name": "ALEJANDRO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-12",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AL",
            "license": "MD.43518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

Verify at the official NPI Registry.