NPIMap

Individual provider Active NPI

Jaime O Bolano, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1497854038
Registry record updated Jul 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036061720 Issued in IL
Practice address
2209 W Cermak Rd
Chicago, IL 60608-3916
Phone
(773) 847-1199
Fax
(773) 847-6592
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036061720 IL Primary

Addresses

Primary practice location

2209 W Cermak Rd
Chicago, IL 60608-3916

Mailing address

2209 W Cermak Rd
Chicago, IL 60608-3916
Phone (773) 847-1199

Other identifiers 2

IdentifierTypeStateIssuer
036061720MedicaidIL
31620158OtherILBLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100910000485 IL Practitioner - Internal Medicine 2062537335 Practice locations: Chicago, IL

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2209 W Cermak Rd
Chicago, IL 60608-3916
Phone (773) 847-1199

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437609600000",
    "number": "1497854038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 W CERMAK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606083916",
            "telephone_number": "773-847-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 W CERMAK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606083916",
            "telephone_number": "773-847-1199",
            "fax_number": "773-847-6592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLANO",
        "first_name": "JAIME",
        "middle_name": "O",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2015-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036061720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036061720",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "31620158",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.