John Bolla

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME0069906 Issued in FL

Practice address

9835 Lake Worth Rd Ste 16
Lake Worth, FL 33467-2370

Phone

(251) 495-2990

NPI assigned

Jan 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• I&N Max Group LLC

  • Family Medicine Physician
  • Lake Worth, FL
  • NPI 1396636726
  NPD Authorized official
• Adventhealth Primary Care Network Inc

  • Family Medicine Physician
  • Altamonte Springs, FL
  • NPI 1093493637
  NPD (past)

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1396723581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9835 LAKE WORTH RD STE 16",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334672370",
            "telephone_number": "251-495-2990",
            "fax_number": "514-952-9903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9835 LAKE WORTH RD STE 16",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334672370",
            "telephone_number": "251-495-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLA",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0069906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252225000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blue Village Transportation LLC.
• Blue Water Doctors of Lake Worth LLC
• Peri Michelle Blum, PSY.D.
• Kaylin Boas, M.S., CF-SLP
• Body Care Medspa LLC
• Yazmin Bonet, LCSW
• Ryan Samuel Bonilla, MPT
• Natasha Borbolla, RBT
• Daniela Borges Lopez
• David Barry Bornstein, RPH

• Family Medicine Physician in Lake Worth, FL
• Providers in Lake Worth, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; 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.