Mariam H Bokolishvili, S.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

15-489

Practice address

1511 W Alameda St
Santa Fe, NM 87501-1746

Phone

(505) 459-3988

NPI assigned

May 3, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mariam Bokolishvili Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1225564800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 W ALAMEDA ST",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011746",
            "telephone_number": "505-459-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 W ALAMEDA ST",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011746",
            "telephone_number": "505-459-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOKOLISHVILI",
        "first_name": "MARIAM",
        "middle_name": "H",
        "credential": "S.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-03",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": null,
            "license": "15-489",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": "15-489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIAM",
            "last_name": "BOKOLISHVILI",
            "credential": "M.D., S.A.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Surgical Physician Assistant in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Surgical Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.