Bhasakara P Bolisetty, M.D.
Individual provider Active NPI Internal Medicine Physician · Cleveland, OH
NPI 1710046263 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1710046263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 35.063292 (OH)
- Practice address
- 1708 Southpoint Dr
Cleveland, OH 44109-1911 - Phone
- (216) 787-0500
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- State of Ohio Office of Budget and Management State Accounting
Practice addresses (Care Compare)
1756 Sagamore Rd
Northfield, OH 44067-1086
Phone (330) 833-3135
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20110325000181 | OH | Practitioner - Internal Medicine | 3274716469 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.063292 | OH | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Ohio Office of Budget and Management State Accounting | Current | Accepting new patients | |
| State of Ohio Office of Budget and Management State Accounting | Current |
Accepting new patients | |
| State of Ohio Office of Budget and Management State Accounting | Current |
Accepting new patients | |
| State of Ohio Office of Budget and Management State Accounting | Past | Accepting new patients |
Locations
30 E Broad St
Fl 11
Columbus, OH 43215
Phone (614) 466-9930
1756 Sagamore Rd
Rm 312
Northfield, OH 44067
1756 Sagamore Rd
Northfield, OH 44067
Phone (330) 467-7131
Interoperability endpoints
- bbolisetty18934@mhas.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35.063292 | OH | Yes |
Addresses
Primary practice location
1708 Southpoint Dr
Cleveland, OH 44109-1911
Mailing address
30 E Broad St
11TH FL Attn Tonya Fasone
Columbus, OH 43215-3414
Phone (614) 466-9930
NPI Registry JSON
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710046263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 E BROAD ST",
"address_2": "11TH FL ATTN TONYA FASONE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432153414",
"telephone_number": "614-466-9930",
"fax_number": "614-644-9116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1708 SOUTHPOINT DR",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441091911",
"telephone_number": "216-787-0500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLISETTY",
"first_name": "BHASAKARA",
"middle_name": "P",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "35.063292",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.