Jacqueline Bolin

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1157 S Crismon Rd
Mesa, AZ 85208-2661

Phone

(480) 776-3790

NPI assigned

Mar 18, 2021

Last updated

Jan 10, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Glendale Pediatrics LLC

  • Family Medicine Physician
  • Glendale, AZ
  • NPI 1336335983
  Medicare reassignment
• Centro Medico del Valle PC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1205160355

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1616025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1275119521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14247 S 47TH PL",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850446206",
            "telephone_number": "480-521-3825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1157 S CRISMON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852082661",
            "telephone_number": "480-776-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIN",
        "first_name": "JACQUELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-18",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darieika Boizan Calzado
• Amivi S Boko
• Lea-Amber Bolduc, NP
• Thecla Bolger, RNNNP
• Veronica Bolick, NP
• Susan Bolotin
• Neha Bomb, RDN
• Candice Gibbons Bond, CCC-SLP
• Dallin Bond
• Ian Douglas Bond, MD

• Physician Assistant in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.