Individual provider Active NPI

Richard Charles Bollin Jr., MD

  • Anesthesiology Physician
  • Fullerton, CA
National Provider Identifier
1306898366
Registry record updated Feb 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A72838 Issued in CA
Practice address
101 E Valencia Mesa Dr
Fullerton, CA 92835-3809
Phone
(714) 871-3280
Fax
(714) 447-6490
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A72838 CA Primary

Addresses

Primary practice location

101 E Valencia Mesa Dr
Fullerton, CA 92835-3809

Mailing address

PO Box 1628
Orange, CA 92856-0628
Phone (714) 560-1580

Other identifiers 1

IdentifierTypeStateIssuer
00A728380MedicaidCA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100927000771 CA Practitioner - Anesthesiology 9032235155 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Loma Linda University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allied Anesthesia Medical Group IncGroup PAC ID 6103728407, 185 clinicians

Practice addresses (Care Compare)

1124 S Main St
Suite 101
Corona, CA 92882-4449
Phone (951) 737-6363

Hospital & facility affiliations

  • Providence St. Jude Medical Center Hospital, Fullerton, CA, CCN 050168

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
72838CAMDPediatric Pharmacist
A72838CAMDAnesthesiology Physician

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424304000000",
    "number": "1306898366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1628",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928560628",
            "telephone_number": "714-560-1580",
            "fax_number": "714-560-1585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E VALENCIA MESA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353809",
            "telephone_number": "714-871-3280",
            "fax_number": "714-447-6490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLIN",
        "first_name": "RICHARD",
        "middle_name": "CHARLES",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2015-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A72838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A728380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.