Mark Bollman, M.D.

Primary specialty

Pediatric Hospice and Palliative Medicine PhysicianTaxonomy code 2080H0002X

License

R3478 Issued in TX

Practice address

1015 NW 22ND Ave
Portland, OR 97210-3025

Phone

(503) 220-1000

NPI assigned

Apr 15, 2014

Last updated

Sep 13, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in OR

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

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.

• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272
  Medicare reassignment NPD

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

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536796800000",
    "number": "1164841219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-3900",
            "fax_number": "503-413-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-220-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLMAN",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-15",
        "last_updated": "2018-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080H0002X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Hospice and Palliative Medicine",
            "state": "TX",
            "license": "R3478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua William Bolle
• Marie Boller, MD
• Tasha Marie Bollermann, D.M.D.
• Erica Ruth Bolliger, SEP, LMT, FNTP, MDIV
• Michelle Lynn Bolling, LMT
• Alexandra Cerutti Bolognese, MD, PHD
• Rachel K. Bolognone, M.S. SLP-CCC
• Tracy Bolsinger
• Laura Bolt, PA-C
• Bruce K. Bolton, MD

• Pediatric Hospice and Palliative Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Pediatric Hospice and Palliative Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; 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.