Mark Buboltz, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

3376 Issued in MN

Practice address

9801 Dupont Ave S
Suite 200
Bloomington, MN 55431-3100

Phone

(952) 888-5800

NPI assigned

Jun 3, 2014

Last updated

Jun 11, 2014By 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 MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Minnesota Eye Consultants, PAGroup PAC ID 4284524539, 34 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

80.11 of 100Reported as group

Quality

73.53

Promoting interoperability

100

Improvement activities

40

Cost

60.18

Medicare enrollment (NPD)

Enrolled

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.

• Minnesota Eye Consultants, PA

  • Ophthalmology Physician
  • Bloomington, MN
  • NPI 1508839879

  Corneal and Contact Management

  Medicare reassignment Care Compare group NPD
• Minnesota Eye Consultants, PA

  • Ophthalmology Physician
  • Minnetonka, MN
  • NPI 1932173374

  Corneal and Contact Management

  NPD (past)
• Minnesota Eye Laser & Surgery Centers, LLC

  • Ambulatory Surgical Clinic/Center
  • Woodbury, MN
  • NPI 1578003208
  NPD (past)
• Northwest Eye Clinic, LLC

  • Ophthalmology Physician
  • St Anthony, MN
  • NPI 1255417002
  NPD (past)

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1205249620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S",
            "address_2": "SUITE 425",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313100",
            "telephone_number": "952-888-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S",
            "address_2": "SUITE 200",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313100",
            "telephone_number": "952-888-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBOLTZ",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-03",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MN",
            "license": "3376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annika Bruestle
• Ashley Nicole Bruggeman
• Connie Bruhn
• Dillon Bruxvoort
• Stephani Louise Bruyer, M.A.
• Beverly Denise Buchanan, M.A., LMFT, LADC
• Kiley Buchanan
• Michelle Kaju Buchl, LADC
• Ryan Buchmeier
• Emma Mae Buckingham

• Corneal and Contact Management Optometrist in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Corneal and Contact Management Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; 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.