Active NPI
Jerry Blake Bolin, M.D.
- Family Medicine Physician
- Frisco, TX
National Provider Identifier
1174563043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- K8014
- Practice address
- 3550 Parkwood Blvd.
BLDG. D, Ste. 405
Frisco, TX 75034 - Phone
- (469) 287-8800
- Fax
- (469) 287-8801
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | K8014 | TX | Primary |
Addresses
Primary practice location
3550 Parkwood Blvd.
BLDG. D, Ste. 405
Frisco, TX 75034
Mailing address
3550 Parkwood Blvd.
BLDG. D. Ste. 405
Frisco, TX 75034
Phone (469) 287-8800
Other names 1
- Dr. J Blake Bolin
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ssmith@jblakebolinmd.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 2, 2023 through Mar 2, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609372800000",
"number": "1174563043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3550 PARKWOOD BLVD.",
"address_2": "BLDG. D. STE. 405",
"city": "FRISCO",
"state": "TX",
"postal_code": "75034",
"telephone_number": "469-287-8800",
"fax_number": "469-287-8801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3550 PARKWOOD BLVD.",
"address_2": "BLDG. D, STE. 405",
"city": "FRISCO",
"state": "TX",
"postal_code": "75034",
"telephone_number": "469-287-8800",
"fax_number": "469-287-8801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLIN",
"first_name": "JERRY",
"middle_name": "BLAKE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2020-12-31",
"certification_date": "2020-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "K8014",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ssmith@jblakebolinmd.com",
"affiliation": "N",
"endpointDescription": "Secure email address",
"address_1": "3550 Parkwood Blvd.",
"address_2": "Bldg. D, Ste. 405",
"city": "Frisco",
"state": "TX",
"country_code": "US",
"postal_code": "75034",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "J BLAKE",
"last_name": "BOLIN",
"prefix": "DR.",
"credential": "MD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Frisco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.