Joe Randolph Bolton, MD

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

G88027 Issued in CA

Practice address

1377 E Herndon Ave
#104
Fresno, CA 93720-3022

Phone

(559) 450-7455

Fax

(559) 450-7473

NPI assigned

Oct 10, 2006

Last updated

Jan 16, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Stanford Health Care

  dba Stanford Medical Center A Trade Name for Stanford Health Care

  • General Acute Care Hospital
  • Stanford, CA
  • NPI 1437292927

  Thoracic Surgery (Cardiothoracic Vascular Surgery)

  NPD (past)
• Dignity Health

  dba Dignity Health St. Rose Specialty Clinics

  • Neurological Surgery Physician
  • Henderson, NV
  • NPI 1720358039
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326672000000",
    "number": "1518055441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 E HERNDON AVE",
            "address_2": "#104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203022",
            "telephone_number": "559-450-7455",
            "fax_number": "559-450-7473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1377 E HERNDON AVE",
            "address_2": "#104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203022",
            "telephone_number": "559-450-7455",
            "fax_number": "559-450-7473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "JOE",
        "middle_name": "RANDOLPH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2012-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "TX",
            "license": "J3436",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "G88027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edith Saavedra Boldt, N.P.
• Samaria Nechell Boles, RBT
• Bolkiki Medical Supplies and Equipment, Inc.
• Sanjana Bolleddu
• Jeremy Vincent Bolton, PH.D.
• Anne Michelle Bomar
• Megan Bomar
• Bonavente Corporation (Bonavente Laureen Home)
• Bonavente Corporation (Bonavente Fremont Home)
• Bonavente Icf DDN Home

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Fresno, CA
• Providers in Fresno, CA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.