Bola Elemuren MD. PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

K4050 Issued in TX

Legal business name

BOLA ELEMUREN MD. PA

Doing business as

Family Medicine Clinic

Practice address

740 S Amy LN
Ste 101
Harker Heights, TX 76548-1343

Phone

(254) 699-8521

Fax

(254) 699-8528

NPI assigned

Sep 5, 2007

Last updated

Jan 10, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

BOLA ELEMUREN MD.PAAs reported in NPPES

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

Authorized official

Name

Dr. Iyabo Bola Elemuren, M.D

Title

Owner

Phone

(254) 699-8521

Specialties & licenses 2

Addresses

Other names 1

• FAMILY MEDICINE CLINIC Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Part of

Bola Elemuren MD PA

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maheswari Chinimilli, M.D.

  • Family Medicine Physician
  • Georgetown, TX
  • NPI 1588860811
  NPD (past)
• Stephanie Page, DNP, APRN, FNP-C

  • Family Nurse Practitioner
  • Temple, TX
  • NPI 1942432828
  NPD (past)
• Brian Matthew Powell, P.A.

  • Medical Physician Assistant
  • Harker Heights, TX
  • NPI 1437371663
  NPD (past)
• Anuradha Rangarajan, M.D.

  • Family Medicine Physician
  • Round Rock, TX
  • NPI 1225057516
  NPD (past)
• Vineet Gupta, M.D.

  • Family Medicine Physician
  • Yuba City, CA
  • NPI 1598806390
  NPD (past)

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1598959389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 S AMY LN",
            "address_2": "STE 101",
            "city": "HARKER HEIGHTS",
            "state": "TX",
            "postal_code": "765481343",
            "telephone_number": "254-699-8521",
            "fax_number": "254-699-8528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 S AMY LN",
            "address_2": "STE 101",
            "city": "HARKER HEIGHTS",
            "state": "TX",
            "postal_code": "765481343",
            "telephone_number": "254-699-8521",
            "fax_number": "254-699-8528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLA ELEMUREN MD. PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOLA ELEMUREN MD.PA",
        "enumeration_date": "2007-09-05",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "ELEMUREN",
        "authorized_official_first_name": "IYABO",
        "authorized_official_middle_name": "BOLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "254-699-8521",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01547",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K4050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY MEDICINE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Crystal Sue Black, FNP-C
• Lakeisha Vashawn Blackshear
• Traci Lynn Blanco
• Donald Gene Bockin, O.D.
• Andrea Leigh Boen, LPC
• Jennifer Bolden
• Ana P Bonaldi, OD
• Jose A Bonilla-Negron
• Tanganeka Booker-Reed
• Ann Marie Boone, PHARMD

• Family Medicine Physician in Harker Heights, TX
• Providers in Harker Heights, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; 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.