Keerthana Nagavenkata Bolisetty, MD

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

S1985 Issued in TX

Practice address

1007 W Randol Mill Rd Ste 110
Arlington, TX 76012-6503

Phone

(817) 617-7678

Fax

(817) 617-7678

NPI assigned

Mar 30, 2015

Last updated

Oct 23, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Ophthalmology

Education

Ohio State University College of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alliance Retina of Texas PLLCGroup PAC ID 4183998560, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135

Merit-based Incentive Payment System (MIPS)

Final score

98.35 of 100Reported as group

Quality

95

Promoting interoperability

98

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: k.bolisetty@drkimmai.emadirect.md

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.

• Alliance Retina of Texas, PLLC

  dba Alliance Retina

  • Retina Specialist (Ophthalmology) Physician
  • Fort Worth, TX
  • NPI 1346787157
  Medicare reassignment Care Compare group NPD
• Alliance Ophthalmology, PLLC

  dba Alliance Vision Institute

  • Ophthalmology Physician
  • Fort Worth, TX
  • NPI 1912450164
  NPD (past)

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

• Texas Health Harris Methodist Hospital Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1336172105
  Care Compare affiliation

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

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666483200000",
    "number": "1407241284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3824 N TARRANT PKWY STE 310",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762445431",
            "telephone_number": "817-617-7678",
            "fax_number": "817-617-7681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 W RANDOL MILL RD STE 110",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760126503",
            "telephone_number": "817-617-7678",
            "fax_number": "817-617-7678"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5323 Harry Hines Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "753907201",
            "country_code": "US",
            "telephone_number": "214-648-0464",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3824 N Tarrant Pkwy Ste 310",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "762445431",
            "country_code": "US",
            "telephone_number": "817-617-7678",
            "fax_number": "817-617-7681",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLISETTY",
        "first_name": "KEERTHANA",
        "middle_name": "NAGAVENKATA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-30",
        "last_updated": "2022-10-23",
        "certification_date": "2022-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "S1985",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "TX",
            "license": "S1985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400383205",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Lee Bohanan, ATC, CSCS
• Lashaunn Bold, LCSW
• Christa A Bolden, NP
• Laurie Bolene
• James Bolgiano, M.S.
• Amber Lynn Bollinger
• Theronica Roosetta Bond, MD
• Karen Bonham, PA-C
• Kimberly Theresa Bonner
• Stephanie Bonner

• Retina Specialist (Ophthalmology) Physician in Arlington, TX
• Providers in Arlington, TX by specialty
• Retina Specialist (Ophthalmology) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.