Bryan E Bolen, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

5101026250 Issued in MI

Practice address

909 Wilson Rd RM B119
East Lansing, MI 48824-6410

Phone

(517) 353-3070

Fax

(517) 884-1817

NPI assigned

Jun 13, 2019

Last updated

Nov 27, 2023By 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

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Michigan State University College of Osteopathic Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Msu Health Care Inc.Group PAC ID 8628404936, 201 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bryan.bolen.1@25394.direct.athenahealth.com

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.

• Msu Health Care Inc

  • Allergy & Immunology Physician
  • East Lansing, MI
  • NPI 1700418670
  Medicare reassignment Care Compare group NPD
• Montcalm Care Network

  • Community/Behavioral Health Agency
  • Stanton, MI
  • NPI 1710074448
  Medicare reassignment NPD
• Community Mental Health Authority Clinton Eaton Ingham Counties

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lansing, MI
  • NPI 1265483457

  Psychiatry

  NPD
• Michigan State University

  • Psychiatry Physician
  • East Lansing, MI
  • NPI 1164973418
  NPD
• Msu Health Care Inc.

  • Psychiatry Physician
  • East Lansing, MI
  • NPI 1588296552
  NPD
• Msu Health Care Inc.

  • Physical Therapist
  • East Lansing, MI
  • NPI 1689206419
  NPD
• Msu Health Care Inc.

  • Diagnostic Radiology Physician
  • East Lansing, MI
  • NPI 1275165052
  NPD (past)

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1548820467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A109B",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-353-3070",
            "fax_number": "517-884-1817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 WILSON RD RM B119",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488246410",
            "telephone_number": "517-353-3070",
            "fax_number": "517-884-1817"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "812 E Jolly Rd",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489106818",
            "country_code": "US",
            "telephone_number": "517-346-8318",
            "fax_number": "517-346-8291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLEN",
        "first_name": "BRYAN",
        "middle_name": "E",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-13",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5101026250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharalee Boda
• Shelby Boelens
• Maribeth Bohlman
• Abigail Lyn Bokor
• Chanda Bolander, LLMSW
• Maryanne K Boltz, LMSW
• Madelaine Bombard, LMT
• Shana Lin Bombrys, LMSW
• Diana Bonaccorsi, DO
• Tejas Bondade, D.O.

• Psychiatry Physician in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.