NPIMap

Individual provider Active NPI

Michael Shawn Bolan, D.O.

  • Family Medicine Physician
  • Kentwood, MI
National Provider Identifier
1659488807
Registry record updated Aug 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101009303 Issued in MI
Practice address
2272 32ND St SE
Kentwood, MI 49508-1509
Phone
(616) 247-0399
Fax
(616) 247-0499
NPI assigned
Aug 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2014

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 5101009303 MI Primary

Addresses

Primary practice location

2272 32ND St SE
Kentwood, MI 49508-1509

Mailing address

2272 32ND St SE
Kentwood, MI 49508-1509
Phone (616) 247-0399

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20140730000763 WI Practitioner - Family Practice 0941467195 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Wausau Hospital IncGroup PAC ID 6406757442, 242 clinicians

Practice addresses (Care Compare)

333 Pine Ridge Blvd
Wausau, WI 54401-4102
Phone (715) 847-2866

Hospital & facility affiliations

  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030

Merit-based Incentive Payment System (MIPS)

Final score
90.56 of 100Reported as group
Quality
87.43
Promoting interoperability
100
Improvement activities
40
Cost
78.24

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Medical Group, Inc. CurrentSince Sep 11, 2014 Accepting new patients
Aspirus Medical Group, Inc. CurrentSince Sep 11, 2014 Accepting new patients
Aspirus Wausau Hospital, Inc. Family Medicine CurrentSince Mar 1, 2020 Accepting new patients
Aspirus Wausau Hospital, Inc. Current Accepting new patients
Aspirus Wausau Hospital, Inc. CurrentSince Mar 1, 2020 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

4005 Community Center Dr
Weston, WI 54476
Phone (715) 241-5400

Interoperability endpoints

  • Direct secure messaging: mbolan101237@direct.aspirus.org

Organizations & group practices 6

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.

Hospital & facility affiliations 10

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407974400000",
    "number": "1659488807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2272 32ND ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495081509",
            "telephone_number": "616-247-0399",
            "fax_number": "616-247-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2272 32ND ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495081509",
            "telephone_number": "616-247-0399",
            "fax_number": "616-247-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAN",
        "first_name": "MICHAEL",
        "middle_name": "SHAWN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2014-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101009303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, MI

Sources for this page

Verify at the official NPI Registry.