Jonathan Peter Boltax, MD
Individual provider Active NPI Pulmonary Disease Physician · Jackson, WY
NPI 1629023692 · NPPES record last updated Jan 4, 2024
Key facts
- NPI
- 1629023692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- License
- 9935A (WY)
- Practice address
- 555 E Broadway Ave Ste 220
Jackson, WY 83001-8640 - Phone
- (307) 739-7305
- Fax
- (307) 739-4960
- NPI assigned
- May 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Pulmonary Disease
- Education
- Temple University School of Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Teton County Hospital District
Practice addresses (Care Compare)
555 E Broadway Ave
Suite 220
Jackson, WY 83001-8640
Phone (307) 739-7690
Hospital & facility affiliations
- St Johns Medical Center
- Sagewest Health Care
- Star Valley Medical Center
- Sublette County Health
- CCN 531320
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150324002473 | WY | Practitioner - Pulmonary Disease | 3577504695 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | 9935A | WY | Yes |
Addresses
Primary practice location
555 E Broadway Ave Ste 220
Jackson, WY 83001-8640
Mailing address
PO Box 428
Jackson, WY 83001-0428
Phone (307) 739-7305
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121002500 | Medicaid | WY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jboltax@sjmc.cernerdirect.com | Direct |
Other providers in Jackson, WY
- Blackburn Drug LLC
- James Edward Blackburn Jr.
- Philip C Blum
- Peter G. Blumenauer
- Carol Bocker
- Marianne Rosenwald Boschen
- Ashley Lynn Bostyan
- Lori L. Bowdler
- Whitney Boyce
- Jennifer M Bradof
All providers in Jackson, WY · Pulmonary Disease Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.