Alexis Rae Bolton

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95014147 Issued in CA

Practice address

11500 Brookshire Ave
Downey, CA 90241-4917

Phone

(562) 904-5000

Fax

(562) 904-5140

NPI assigned

Jul 28, 2020

Sex

Female

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 CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Luke Macyszyn MD IncGroup PAC ID 2769850577, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cedar-Sinai Marina del Rey Hospital Hospital, Marina del Rey, CA, CCN 050740

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Luke Macyszyn MD Inc

  • Neurological Surgery Physician
  • Marina del Rey, CA
  • NPI 1104543354
  Medicare reassignment Care Compare group NPD

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

• Cedars-Sinai Marina Hospital

  • General Acute Care Hospital
  • Marina del Rey, CA
  • NPI 1942269725
  Care Compare affiliation

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1215546197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 BROOKSHIRE AVE",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902414917",
            "telephone_number": "562-904-5000",
            "fax_number": "562-904-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11500 BROOKSHIRE AVE",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902414917",
            "telephone_number": "562-904-5000",
            "fax_number": "562-904-5140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "ALEXIS",
        "middle_name": "RAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-28",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95014147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keyonah C. Blunt
• Eirik Christian Blydt-Hansen, P.T.
• Jamie D Bodie, OTR/L
• William Boelter, M.D.
• Kristy Ann Bolster, NURSE PRACTITIONER
• Araceli Bonilla
• Dalila Maricela Bonilla
• Lizette Bonilla, LCSW
• Ricardo Emmanuel Bonilla
• Vincent Bonilla, LMFT

• Family Nurse Practitioner in Downey, CA
• Providers in Downey, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.