Individual provider Active NPI

Cindy Ann Bolter, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Walnut Creek, CA
National Provider Identifier
1245459544
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
17440 Issued in CA
Practice address
2970 Camino Diablo Ste 300
Walnut Creek, CA 94597-4001
Phone
(925) 282-1778
Fax
(415) 296-5299
NPI assigned
Apr 25, 2007
Last updated
Apr 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 17440 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 17440 CA Primary
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist 364SP0807X RN336646 CA
Psychiatric/Mental Health Registered Nurse 163WP0808X RN336646 CA

Addresses

Primary practice location

2970 Camino Diablo Ste 300
Walnut Creek, CA 94597-4001

Mailing address

2970 Camino Diablo Ste 300
Walnut Creek, CA 94597-4001
Phone (925) 282-1778

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210526001589 CA Practitioner - Nurse Practitioner 7618376526 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

2970 Camino Diablo
Suite 300
Walnut Creek, CA 94597-4001
Phone (925) 282-1778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN336646CAMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Psychiatric Associates Inc CurrentSince Mar 20, 2024 Accepting new patients

Locations

1480 64th St
Ste 150
Emeryville, CA 94608
Phone (415) 296-5292

675 S Arroyo Pkwy
Ste 420
Pasadena, CA 91105
Phone (626) 795-0617

490 Post St
Ste 1043
San Francisco, CA 94102
Phone (415) 409-0944

2970 Camino Diablo
Ste 300
Walnut Creek, CA 94597
Phone (925) 231-4225

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.cindybolter@148377.advancedmd-direct.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1245459544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2970 CAMINO DIABLO STE 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945974001",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 CAMINO DIABLO STE 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945974001",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTER",
        "first_name": "CINDY",
        "middle_name": "ANN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "17440",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "17440",
            "primary": true
        },
        {
            "code": "364SP0807X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Adolescent",
            "state": "CA",
            "license": "RN336646",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "RN336646",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.