Traci M Bologna-Jill, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

DPM00367 Issued in RI

Practice address

1 Randall SQ Ste 408
Providence, RI 02904-7405

Phone

(401) 453-2000

Fax

(401) 253-2002

NPI assigned

Apr 2, 2018

Last updated

Dec 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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 RI, MA2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Podiatry

Education

New York College of Podiatric Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lepoer Podiatry, Inc.Group PAC ID 3870920838, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lepoer Podiatry, Inc.

  • Clinic/Center
  • Providence, RI
  • NPI 1871123372

  Foot & Ankle Surgery

  Medicare reassignment Care Compare group NPD
• Lepoer Podiatry, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Providence, RI
  • NPI 1487287280

  Foot & Ankle Surgery

  NPD
• University Foot & Ankle Center Inc

  • Foot & Ankle Surgery Podiatrist
  • Smithfield, RI
  • NPI 1134894603
  NPD
• University Foot & Ankle Center Inc

  • Foot & Ankle Surgery Podiatrist
  • Providence, RI
  • NPI 1437235017
  NPD

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1346746062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RANDALL SQ STE 408",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029047405",
            "telephone_number": "401-453-2000",
            "fax_number": "401-253-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RANDALL SQ STE 408",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029047405",
            "telephone_number": "401-453-2000",
            "fax_number": "401-253-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLOGNA-JILL",
        "first_name": "TRACI",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-02",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "RI",
            "license": "DPM00367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori B Boivin, OD
• Areta L Bojko, MD
• Steven Bokshan, MD
• Jose Bolanos, MD
• Olivia Karen Boling
• Marianne Bonanno, MD
• Andrea Ruth Bonas, NP-C
• Steven J Bonauto, M.D.
• Tamara S. Bond, RN
• Sophia Bonenfant, DO

• Foot & Ankle Surgery Podiatrist in Providence, RI
• Providers in Providence, RI by specialty
• Foot & Ankle Surgery Podiatrist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.