Jonell Hamilton Bolton
Individual provider Active NPI Pediatrics Physician · Walker, LA
NPI 1144529959 · NPPES record last updated Jan 15, 2021
Key facts
- NPI
- 1144529959
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 207163 (LA)
- Practice address
- 5000 O'Donovan Blvd
Suite 404
Walker, LA 70785-6351 - Phone
- (225) 271-6550
- Fax
- (225) 271-6551
- NPI assigned
- Mar 18, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141113001634 | LA | Practitioner - Pediatric Medicine | 1658593371 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 207163 | LA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Our Lady of the Lake Physician Group LLC | Current |
Accepting new patients | |
| Our Lady of the Lake Physician Group LLC | Pediatrics | Current |
Accepting new patients |
| Our Lady of the Lake Physician Group LLC | Past | Accepting new patients | |
| Woman'S Hospital Foundation | Past | Accepting new patients |
Locations
5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011
5000 Odonavan Blvd
Ste 507
Walker, LA 70785
Phone (225) 214-3199
5000 Odonavan Blvd
Ste 50
Walker, LA 70785
5000 Odonavan Blvd
Walker, LA 70785
Phone (225) 214-4200
5000 Odonavan Blvd
Ste 404
Walker, LA 70785
Phone (225) 369-8100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 207163 | LA | Yes |
Addresses
Primary practice location
5000 O'Donovan Blvd
Suite 404
Walker, LA 70785-6351
Mailing address
5000 O'Donovan Blvd
Suite 404
Walker, LA 70785-6351
Phone (225) 271-6550
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2149890 | Medicaid | LA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0830.epihosted.com/FHIRPoxy/api/FHIR/DSTU2/ | Other | |
| Direct Messaging Address | jbolton9126@direct.casso.us.com | Direct |
Other providers in Walker, LA
- Nicole B Barnum
- Baton Rouge Orthopaedic Clinic LLC
- Alicia Baughman
- Megan Price Berthelot
- Heather M Boley
- Donny Luke Bourgeois
- Candace Fairchild Bozeman
- April Danielle Brown
- Dung Bui
- Brooke Byrd
All providers in Walker, LA · Pediatrics Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2021. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.