Doug Bolton, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071005517 Issued in IL

Practice address

5100 N Ravenswood Ave Ste 225
Chicago, IL 60640-1752

Phone

(872) 241-9337

Fax

(872) 241-9338

NPI assigned

Mar 29, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bloom Therapy LLC

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1588278634
  NPD (past)
• John P Frampton, PC

  • Clinical Child & Adolescent Psychologist
  • Chicago, IL
  • NPI 1902277247
  NPD (past)

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

{
    "created_epoch": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553817600000",
    "number": "1639630718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 N RAVENSWOOD AVE STE 225",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401752",
            "telephone_number": "872-241-9337",
            "fax_number": "872-241-9338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 N RAVENSWOOD AVE STE 225",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401752",
            "telephone_number": "872-241-9337",
            "fax_number": "872-241-9338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "DOUG",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-29",
        "last_updated": "2019-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDFPR",
            "identifier": "071005517",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dbolton@fpschicago.com",
            "affiliation": "N",
            "endpointDescription": "Work Emaill",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5100 N Ravenswood Ave Ste 225",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606401752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maryam Bolouri, MD
• Boltem Inc
• Katherine Marie Bolten
• Anna Bolton, D.P.T.
• Brian Daniel Bolton, M.D.
• Elizabeth Miller Bolton
• Katherine Ann Bolton, LCSW, CADC
• Ryan J Bolton, MD
• Matthew Gregory Boltz
• Suzanne Parwanneh Bolur

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2019; 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.