Alonso Bolivar, PA-C
Individual provider Active NPI Physician Assistant · Dedham, MA
NPI 1649941709 · NPPES record last updated Nov 14, 2023
Key facts
- NPI
- 1649941709
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA9018 (MA)
- Practice address
- 983 Boston-Providence Turnpike
Dedham, MA 02026 - Phone
- (781) 819-6400
- NPI assigned
- Sep 27, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physicians Immediate Care North Chicago LLC
Convenientmd - FFS UC LLC
Practice addresses (Care Compare)
1420 Busse Rd
Elk Grove Village, IL 60007-5324
Phone (847) 653-0142
1702 N Milwaukee Ave
Chicago, IL 60647-5424
Phone (773) 770-4056
2201 Oak Park Ave
Berwyn, IL 60402-2220
Phone (312) 324-0222
245 Hartford Ave
Bellingham, MA 02019-3007
Phone (774) 295-4355
3909 N Western Ave
Chicago, IL 60618-3741
Phone (773) 739-9200
405 W Golf Rd
Schaumburg, IL 60195-3501
Phone (224) 215-0011
4211 N Cicero Ave
Chicago, IL 60641-1651
Phone (773) 794-1000
4900 N Cumberland Ave
Norridge, IL 60706-2901
Phone (708) 456-1600
5228 N Northwest Hwy
Chicago, IL 60630-4620
Phone (773) 770-4707
5961 N Lincoln Ave
Chicago, IL 60659-3758
Phone (312) 702-3923
600 W Adams St
Chicago, IL 60661-3604
Phone (312) 506-0900
6140 N Broadway St
Chicago, IL 60660-2538
Phone (773) 435-9028
7425 Barrington Rd
Hanover Park, IL 60133-2241
Phone (630) 823-0392
811 S State St
Chicago, IL 60605-2225
Phone (312) 566-9510
825 S State St
Chicago, IL 60605-2225
Phone (312) 566-9510
8630 W Golf Rd
Niles, IL 60714-5600
Phone (847) 299-0009
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MA, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221215001747 | MA | Practitioner - Physician Assistant | 9133598097 | Reassigns benefits to 1 organization |
| I20250910003207 | IL | Practitioner - Physician Assistant | 9133598097 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9018 | MA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Convenientmd - FFS UC LLC | Current |
Accepting new patients | |
| Convenientmd - FFS UC LLC | Current |
Accepting new patients | |
| Convenientmd LLC | Past | Accepting new patients | |
| Convenientmd LLC | Past | Accepting new patients |
Locations
245 Hartford Ave
Bellingham, MA 02019
Phone (774) 295-4355
40 Davis Straits
Falmouth, MA 02540
Phone (774) 255-3010
111 New Hampshire Ave
Portsmouth, NH 03801
360 US Highway 1 Byp
Unit 102
Portsmouth, NH 03801
Phone (603) 410-6700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9018 | MA | Yes |
Addresses
Primary practice location
983 Boston-Providence Turnpike
Dedham, MA 02026
Mailing address
360 US Highway 1 Byp Unit 102
Portsmouth, NH 03801-7105
Phone (603) 410-6700
Other providers in Dedham, MA
- Thrishline Blaise
- David G Blom
- BMSH II LCB Dedham Ma LLC
- Rose Thomas Bobby
- Emily Mary Bojorquez
- Samantha Maria Bolivar
- Michelle Bolser
- Rebekah Ann Boral
- Pietro Bortoletto
- Boston Eye Blink LLC
All providers in Dedham, MA · Physician Assistant in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2023. 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.