Individual provider Active NPI

Brent L Bolin, MD

  • Family Medicine Physician
  • Louisville, KY
National Provider Identifier
1376508093
Registry record updated Jul 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
33921 Issued in KY
Practice address
7926 Preston Hwy Ste 106
Louisville, KY 40219-3848
Phone
(502) 964-4357
Fax
(502) 966-5948
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 33921 KY Primary

Addresses

Primary practice location

7926 Preston Hwy Ste 106
Louisville, KY 40219-3848

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490

Other identifiers 8

IdentifierTypeStateIssuer
000052154BOtherHUMANA / NMA
1171473OtherPASSPORT / NMA
000000350677OtherANTHEM / NMA
9034053002OtherCIGNA / NMA
012961OtherSIHO / NMA
2440810000OtherPASSPORT ADVANTAGE
1183574OtherCHA / NMA
64012024MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20041220000264 KY Practitioner - Family Practice 1658338892 Reassigns benefits to 2 organizations
I20260530000578 IN Practitioner - Family Practice 1658338892 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Louisville School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

130 Hunter Station Way
Suite 101 Norton Immediate Care
Sellersburg, IN 47172-8931
Phone (812) 248-6020

825 Barret Ave
Louisville, KY 40204-1743
Phone (502) 272-5165

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. CurrentSince Apr 30, 2021 Accepting new patients
Community Medical Associates, Inc. CurrentSince Jan 1, 2005 Accepting new patients
Community Medical Associates, Inc. Family Medicine CurrentSince Jan 1, 2005 Accepting new patients
University of Louisville Physicians, Inc. Family Medicine Current Accepting new patients
Community Medical Associates, Inc. Current Accepting new patients
University of Louisville Physicians, Inc. Family Medicine CurrentSince Apr 30, 2021 Accepting new patients
Norton Enterprises, Inc. Past Accepting new patients
Cincinnati Health Care Group PSC Past Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

130 Hunter Station Way
Ste 101
Sellersburg, IN 47172
Phone (812) 246-4808

7926 Preston Hwy
Ste 106
Louisville, KY 40219
Phone (502) 964-4357

908 DuPont Rd
Louisville, KY 40207
Phone (502) 559-1855

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

7926 Preston Hwy
Louisville, KY 40219
Phone (502) 964-4357

300 High Point Ct
Mt Washington, KY 40047
Phone (502) 447-4595

115 Huston Dr
Ste 1
Shepherdsville, KY 40165
Phone (502) 955-7311

1553 Highway 44 E
Shepherdsvlle, KY 40165
Phone (502) 955-7311

Interoperability endpoints

  • Direct secure messaging: bbolin5407@direct.nortonhealthcare.org

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468022400000",
    "number": "1376508093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7926 PRESTON HWY STE 106",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402193848",
            "telephone_number": "502-964-4357",
            "fax_number": "502-966-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIN",
        "first_name": "BRENT",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2016-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "33921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA / NMA",
            "identifier": "000052154B",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT / NMA",
            "identifier": "1171473",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM / NMA",
            "identifier": "000000350677",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA / NMA",
            "identifier": "9034053002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO / NMA",
            "identifier": "012961",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2440810000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA / NMA",
            "identifier": "1183574",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64012024",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.