NPIMap

Individual provider Active NPI

Timothy L Bollinger, DO

  • Emergency Medicine Physician
  • McHenry, IL
National Provider Identifier
1629013313
Registry record updated Oct 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036106882 Issued in IL
Practice address
3922 Mercy Dr
McHenry, IL 60050-3179
Phone
(815) 578-2020
Fax
(815) 344-4779
NPI assigned
Jun 18, 2006
Last updated
Oct 21, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036106882 IL Primary
Emergency Medicine Physician 207P00000X 52526-21 WI

Addresses

Primary practice location

3922 Mercy Dr
McHenry, IL 60050-3179

Mailing address

3922 Mercy Dr
McHenry, IL 60050-3179
Phone (815) 578-2020

Other identifiers 1

IdentifierTypeStateIssuer
BOLLITIMOtherWIMERCYCARE INSURANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52526-21WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Room Care Providers, S.C. Emergency Medicine PastSince Jul 25, 2019 Accepting new patients
Cottage Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Webster Emergency Physicians Emergency Medicine Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382313600000",
    "number": "1629013313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3922 MERCY DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600503179",
            "telephone_number": "815-578-2020",
            "fax_number": "815-344-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3922 MERCY DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600503179",
            "telephone_number": "815-578-2020",
            "fax_number": "815-344-4779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLINGER",
        "first_name": "TIMOTHY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2013-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036106882",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "52526-21",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCYCARE INSURANCE",
            "identifier": "BOLLITIM",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2013; 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.