NPIMap

Individual provider Active NPI

Bennett Adam Bolyard, D.O.

  • Internal Medicine Physician
  • Springfield, MO
National Provider Identifier
1386986545
Registry record updated Aug 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2016012954 Issued in MO
Practice address
3231 S National Ave
Suite 300
Springfield, MO 65807-7304
Phone
(417) 888-5658
Fax
(417) 841-0104
NPI assigned
Mar 25, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 34.011878 OH
Internal Medicine Physician 207R00000X 2016012954 MO Primary

Addresses

Primary practice location

3231 S National Ave
Suite 300
Springfield, MO 65807-7304

Mailing address

3231 S National Ave
Suite 300
Springfield, MO 65807-7304
Phone (417) 888-5658

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160801002534 MO Practitioner - Internal Medicine 9335377829 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Kansas City College of Medicine and Surgery, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians
Cherry Health Center, LLCGroup PAC ID 1355317033, 97 clinicians

Practice addresses (Care Compare)

2115 S Fremont Ave
2300 MC Internal Medicine Whiteside
Springfield, MO 65804-2233
Phone (417) 841-5600

607 W Battlefield St
Springfield, MO 65807-4123
Phone (417) 869-2000

940 W Mount Vernon St
100 MC Laboratory Services Nixa
Nixa, MO 65714-9613
Phone (417) 724-5220

Hospital & facility affiliations

  • Amedisys Home Health of Missouri Home health agency, Springfield, MO, CCN 267607
  • Integrity Home Care + Hospice Home health agency, Springfield, MO, CCN 267576
  • Phoenix Home Care and Hospice Home health agency, Springfield, MO, CCN 267629
  • Mercy Hospital Springfield Hospital, Springfield, MO, CCN 260065
  • Mercy Hospital Aurora Hospital, Aurora, MO, CCN 261316
  • Mercy Hospital Lebanon Hospital, Lebanon, MO, CCN 260059
  • Mercy St Francis Hospital Hospital, Mountain View, MO, CCN 261335

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2016012954MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities Internal Medicine CurrentSince Jul 16, 2016 Accepting new patients
Mercy Clinic Springfield Communities Internal Medicine CurrentSince Aug 8, 2018 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jul 16, 2016 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

940 W Mount Vernon St
Ste 100
Nixa, MO 65714
Phone (417) 724-5220

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

3231 S National Ave
Ste 300
Springfield, MO 65807
Phone (417) 888-5658

2115 S Fremont Ave
Ste 2300
Springfield, MO 65804
Phone (417) 820-2675

620 S Glenstone Ave
Springfield, MO 65802
Phone (417) 829-4215

Interoperability endpoints

  • Direct secure messaging: bbolyard9393@directc.mercy.net

Organizations & group practices 5

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471564800000",
    "number": "1386986545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 S NATIONAL AVE",
            "address_2": "SUITE 300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658077304",
            "telephone_number": "417-888-5658",
            "fax_number": "417-841-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 S NATIONAL AVE",
            "address_2": "SUITE 300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658077304",
            "telephone_number": "417-888-5658",
            "fax_number": "417-841-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLYARD",
        "first_name": "BENNETT",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-25",
        "last_updated": "2016-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34.011878",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2016012954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.