Diana Bolotin, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036.125194 Issued in IL

Practice address

5841 S Maryland Ave
MC 5067
Chicago, IL 60637-1447

Phone

(773) 834-9821

NPI assigned

Mar 23, 2010

Last updated

Mar 23, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Dermatology

Education

University of Chicago, Pritzker School of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians

The University of Chicago Medical CenterGroup PAC ID 7618880766, 907 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dbolotinmd39963@uchospital.direct-ci.com

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.

• The University of Chicago Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1033218128
  Medicare reassignment Care Compare group NPD
• University of Chicago

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1821048786
  Medicare reassignment Care Compare group NPD
• The University of Chicago Medical Center

  dba UCMC Pharmacy Services

  • Community/Retail Pharmacy
  • Calumet City, IL
  • NPI 1255895678
  NPD

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

• The University of Chicago Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1508956509
  Care Compare affiliation

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

{
    "created_epoch": "1269302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269302400000",
    "number": "1164746905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "address_2": "MC 5067",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371447",
            "telephone_number": "773-834-9821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "address_2": "MC 5067",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371447",
            "telephone_number": "773-834-9821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLOTIN",
        "first_name": "DIANA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-23",
        "last_updated": "2010-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036.125194",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "036.125194",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "IL",
            "license": "036.125194",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Bollow
• James Bolo, LCSW
• Jennifer Bolognani, APRN
• Maureen K Bolon, MD
• Tinna Marie Bolongan, PT
• Maryam Bolouri, MD
• Boltem Inc
• Katherine Marie Bolten
• Anna Bolton, D.P.T.
• Brian Daniel Bolton, M.D.

• Dermatology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2010; 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.
• 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.