Peter R. Bolos, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

ME104023 Issued in FL

Practice address

1208 Merry Water Dr
Lutz, FL 33548-4807

Phone

(813) 477-9979

Fax

(888) 688-1659

NPI assigned

Mar 25, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Advanced Imaging of Port Charlotte

  • Diagnostic Radiology Physician
  • Port Charlotte, FL
  • NPI 1225361850
  NPD (past)
• Synergy Pharmacy Services, Inc.

  dba Synergy Pharmacy Services

  • Pharmacy
  • Palm Harbor, FL
  • NPI 1336455096
  NPD (past)

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473984000000",
    "number": "1457523987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 MERRY WATER DR",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484807",
            "telephone_number": "813-477-9979",
            "fax_number": "888-688-1659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 MERRY WATER DR",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484807",
            "telephone_number": "813-477-9979",
            "fax_number": "888-688-1659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLOS",
        "first_name": "PETER",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-25",
        "last_updated": "2016-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD433914",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "D80591",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME104023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009111600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "14N46",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bhuvan Bodipati
• Gabrielle Bodroghy, IBCLC
• Antony Alexander Boghdadi, DMD
• Samer Boghdady
• Tanya R. Bogle, M.D.
• Gitendra Bommareddy, R.PH
• Terra Bone, LCSW
• Loicy Bonet I, BCBA-1-20-42842
• Kimberly Kathlene Booth, M.S., CCC-SLP
• Karolina Borodo, MD

• Diagnostic Radiology Physician in Lutz, FL
• Providers in Lutz, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.