Active NPI
Issac Isaiah Bolanos, PA
- Medical Physician Assistant
- Austin, TX
National Provider Identifier
1407193840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA08063
- Practice address
- 1313 Red River St
Suite 200
Austin, TX 78701-1943 - Phone
- (512) 391-1751
- Fax
- (512) 391-1906
- NPI assigned
- Jan 4, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA08063 | TX | Primary |
Addresses
Primary practice location
1313 Red River St
Suite 200
Austin, TX 78701-1943
Mailing address
1313 Red River St
Suite 200
Austin, TX 78701-1943
Phone (512) 391-1751
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA08063 | Other | TX | TX LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA08063 | TX | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357257600000",
"number": "1407193840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1313 RED RIVER ST",
"address_2": "SUITE 200",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787011943",
"telephone_number": "512-391-1751",
"fax_number": "512-391-1906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1313 RED RIVER ST",
"address_2": "SUITE 200",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787011943",
"telephone_number": "512-391-1751",
"fax_number": "512-391-1906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLANOS",
"first_name": "ISSAC",
"middle_name": "ISAIAH",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-04",
"last_updated": "2013-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA08063",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TX LICENSE",
"identifier": "PA08063",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.