NPIMap

Individual provider Active NPI

Charles Bolick, MD

  • Family Medicine Physician
  • Bristol, TN
National Provider Identifier
1609870583
Registry record updated Sep 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD 025833 Issued in TN
Practice address
240 Medical Park Blvd
Ste 3000
Bristol, TN 37620-7352
Phone
(423) 990-2400
NPI assigned
Jun 9, 2005
Last updated
Sep 16, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD 025833 TN Primary

Addresses

Primary practice location

240 Medical Park Blvd
Ste 3000
Bristol, TN 37620-7352

Mailing address

PO Box 9
Kingsport, TN 37662-0009
Phone (423) 857-2066

Other identifiers 3

IdentifierTypeStateIssuer
3085962MedicaidTN
5644721MedicaidVA
3085969MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20100810000677 TN Practitioner - Family Practice 2961536198 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Carolina at Chapel Hill School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holston Medical Group PCGroup PAC ID 8224935754, 239 clinicians

Practice addresses (Care Compare)

240 Medical Park Blvd
Suite 3000
Bristol, TN 37620-7352
Phone (423) 990-2400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions18
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD 025833TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Holston Medical Group PC Family Medicine CurrentSince Aug 3, 1998 Accepting new patients
Wellmont Health System Past Accepting new patients

Locations

350 Steeles Rd
#1
Bristol, TN 37620
Phone (423) 844-4925

Interoperability endpoints

  • Direct secure messaging: charlesbolick@hmgpath.allscriptsdirect.net

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253059200000",
    "number": "1609870583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376620009",
            "telephone_number": "423-857-2066",
            "fax_number": "423-857-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MEDICAL PARK BLVD",
            "address_2": "STE 3000",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207352",
            "telephone_number": "423-990-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLICK",
        "first_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2009-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD 025833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3085962",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5644721",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3085969",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

Verify at the official NPI Registry.