Mandy Boltz, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2222222 Issued in AZ

Practice address

1300 N 12TH St
Suite 605
Phoenix, AZ 85006-2848

Phone

(602) 839-4567

NPI assigned

Apr 4, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mandy.boltz@wccphx.eclinicaldirectplus.com
• FHIR API: https://fhir4.healow.com/fhir/r4/EGBDAD/Endpoint/EGBDAD
• Direct secure messaging: mandy.boltz-mmwchc@contexture.medalliesmail.com

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.

• Wesley Community Center Inc

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1396910436
  Medicare reassignment NPD
• Wesley Community Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1144696097
  NPD
• Wesley Community Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Mesa, AZ
  • NPI 1699431726
  NPD
• Wesley Community Center Inc

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1013547686
  NPD (past)

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

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459728000000",
    "number": "1124481353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST",
            "address_2": "SUITE 605",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062848",
            "telephone_number": "602-839-4567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST",
            "address_2": "SUITE 605",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062848",
            "telephone_number": "602-839-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTZ",
        "first_name": "MANDY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-04",
        "last_updated": "2016-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "2222222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerilyn Bollmann, MD
• April Lee Bolton, R.D.N.
• Brandon Lee Bolton, RDN
• Patrick Bradford Bolton, MD
• Tymon Nakia Bolton
• Tina Bolyard, MNS CCC-SLP
• Paul Amadeo Bombino, M.D.
• Faye Louis Bomer, MD
• Carl Albert Bonacci, PH.D.
• Alec Michael Bonaguidi, RD

• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.