Melissa Bolles

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

6493 Issued in MN

Practice address

12700 Whitewater Dr
Minnetonka, MN 55343-9438

Phone

(612) 289-2385

Fax

(844) 897-5371

NPI assigned

Mar 19, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, MI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26566/brand/1/csg/1/fhir/r4
• Direct secure messaging: melissa.bolles.1@26566.direct.athenahealth.com

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.

• Homeward Physicians , PLLC

  • General Practice Physician
  • Marquette, MI
  • NPI 1538828314

  MN

  Medicare reassignment NPD

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

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1699234609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 WHITEWATER DR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553439438",
            "telephone_number": "612-289-2385",
            "fax_number": "844-897-5371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 WHITEWATER DR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553439438",
            "telephone_number": "612-289-2385",
            "fax_number": "844-897-5371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26219 150th St NW",
            "address_purpose": "LOCATION",
            "city": "Zimmerman",
            "state": "MN",
            "postal_code": "553988319",
            "country_code": "US",
            "telephone_number": "612-247-6014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLLES",
        "first_name": "MELISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "6493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boger-Tri Dental, P.L.L.C.
• Kimberly G Bohlig, DDS
• Amanda Bohn, FNP-C
• Kelly Ann Boie, PPCNP-BC
• Tonia Boike, LPCC
• Samuel Bomber, LPCC
• Caycee Jo Bonacci
• Eva Marina Boncich
• Shanequa Boone
• Mara Ann Boonstra, PT, DPT

• Adult Health Nurse Practitioner in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Adult Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.