Michael Todd Bolton, M.D.
Individual provider Active NPI Pediatric Infectious Diseases Physician · Baton Rouge, LA
NPI 1487864708 · NPPES record last updated Jan 18, 2021
Key facts
- NPI
- 1487864708
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Infectious Diseases Physician 2080P0208X
- License
- MD.200870 (LA)
- Practice address
- 8200 Constantin Blvd FL 4
Baton Rouge, LA 70809-3481 - Phone
- (225) 765-5500
- Fax
- (225) 765-1202
- NPI assigned
- May 23, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Louisiana State University School of Medicine in Shreveport, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Our Lady of the Lake Physician Group LLC
Practice addresses (Care Compare)
7777 Hennessy Blvd
Baton Rouge, LA 70808-4363
8300 Constantin Blvd
Baton Rouge, LA 70809-3489
Phone (225) 374-1468
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080422000323 | LA | Practitioner - Emergency Medicine |
9436237146 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD.200870 | LA | MD | Pediatric Infectious Diseases Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Our Lady of the Lake Physician Group LLC | Current |
Accepting new patients | |
| Our Lady of the Lake Physician Group LLC | Current |
Accepting new patients |
Locations
5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011
8200 Constantin Blvd
Fl 4
Baton Rouge, LA 70809
Interoperability endpoints
- mbolton2760@direct.casso.us.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Infectious Diseases Physician | 2080P0208X | MD.200870 | LA | Yes |
Addresses
Primary practice location
8200 Constantin Blvd FL 4
Baton Rouge, LA 70809-3481
Mailing address
7777 Hennessy Blvd
Suite 502
Baton Rouge, LA 70808-4300
Phone (225) 765-6834
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1071871 | Medicaid | LA | |
| 04953094 | Medicaid | MS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mbolton2760@direct.casso.us.com | Direct | |
| FHIR URL | https://epicproxy.et0830.epihosted.com/FHIRPoxy/api/FHIR/DSTU2/ | Other |
Other providers in Baton Rouge, LA
- Tracy Marie Bolgiano
- Amiee Bollich
- Earl Bollinger
- Amanda Robertson Bolton
- Melissa Dawn Bolton
- Robert J Bolton
- Ronald L. Bombet
- Bon Guianza Therapy & Consultancy, LLC
- Martin C Bonacorso
- Britani Mouch Bonadona
All providers in Baton Rouge, LA · Pediatric Infectious Diseases Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.