Kelly Marie Bolin, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN9280600 Issued in FL

Practice address

8702 Hunters Lake Dr Ste 100
Tampa, FL 33647-2855

Phone

(813) 467-4700

Fax

(813) 467-4261

NPI assigned

Nov 17, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Florida Hospital Physician Group IncGroup PAC ID 2365679057, 953 clinicians

Lakeland Regional Health Systems IncGroup PAC ID 8325952914, 513 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Tampa Hospital, Tampa, FL, CCN 100173
• Adventhealth Wesley Chapel Hospital, Wesley Chapel, FL, CCN 100319
• AdventHealth Carrollwood Hospital, Tampa, FL, CCN 100069
• Adventhealth Riverview Hospital, Riverview, FL, CCN 100364
• Adventhealth North Pinellas Hospital, Tarpon Springs, FL, CCN 100055

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: kbolin17257@lrhs.direct-ci.com
• FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
• Direct secure messaging: kbolin624603@adventhealth.direct-ci.com
• Direct secure messaging: kbolin147403@direct.tgh.org

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.

• Florida Hospital Physician Group Inc

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1174955256
  Medicare reassignment Care Compare group NPD
• Lakeland Regional Health Systems, Inc.

  • Multi-Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1497748743
  Medicare reassignment Care Compare group NPD
• University Medical Service Association Inc

  • Physical Therapist
  • Tampa, FL
  • NPI 1992742324
  Medicare reassignment NPD
• Tampa General Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1124558929
  NPD
• University Medical Service Association Inc

  • Durable Medical Equipment & Medical Supplies
  • Tampa, FL
  • NPI 1194276576
  NPD
• University Medical Service Association Inc

  • General Practice Physician
  • Tampa, FL
  • NPI 1326088295
  NPD
• Lakeland Regional Health Systems, Inc.

  • Multi-Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1902241482
  NPD (past)
• Lakeland Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Lakeland, FL
  • NPI 1144228446
  NPD (past)

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

• Adventhealth Riverview Inc

  • General Acute Care Hospital
  • Riverview, FL
  • NPI 1699345314
  Care Compare affiliation
• Pasco-Pinellas Hillsborough Community Health System Inc

  • General Acute Care Hospital
  • Wesley Chapel, FL
  • NPI 1073893020
  Care Compare affiliation
• Tarpon Springs Hospital Foundation Inc

  • General Acute Care Hospital
  • Tarpon Springs, FL
  • NPI 1568473015
  Care Compare affiliation
• University Community Hospital, Inc

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1053321919
  Care Compare affiliation
• University Community Hospital, Inc

  • Clinical Medical Laboratory
  • Tampa, FL
  • NPI 1134766694

  Hospital

  Care Compare affiliation
• University Community Hospital, Inc

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1427068345
  Care Compare affiliation

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

{
    "created_epoch": "1416182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1417353665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8702 HUNTERS LAKE DR STE 100",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472855",
            "telephone_number": "813-467-4700",
            "fax_number": "813-467-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8702 HUNTERS LAKE DR STE 100",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472855",
            "telephone_number": "813-467-4700",
            "fax_number": "813-467-4261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIN",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-17",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN9280600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013953300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y0PZ7",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbolin147403@direct.tgh.org",
            "affiliation": "N",
            "address_1": "4710 S Florida Ave",
            "city": "Lakeland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33813",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbolin17257@LRHS.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4710 S Florida Ave",
            "city": "Lakeland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nia Lillian Bolen-Daniels, OTR
• Brian Keith Bolen, PSY. D., L.M.H.C.
• Charles B. Boles, M.D.
• Bolesta Center, Inc.
• Kassidy Marie Boliek-Gelb
• Claudia Bolivar, COTA/L
• Rishi Raghavendar Bolla
• Sureka Bollepalli, M.D.
• David Anthony Bollinger, R.EEGT,
• Estefany Sabrina Bologna Nino, PHD

• Family Nurse Practitioner in Tampa, FL
• Providers in Tampa, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.