Matthew Bolton, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD21614 Issued in TN

Practice address

1503 S Main St
Crossville, TN 38555-5967

Phone

(931) 484-6196

Fax

(931) 456-1047

NPI assigned

Jun 9, 2005

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• State of Tennessee

  dba Marion County Health Department

  • Public Health or Welfare Agency
  • Jasper, TN
  • NPI 1487791315
  Medicare reassignment NPD
• State of Tennessee

  dba Robertson County Health Department

  • Public Health or Welfare Agency
  • Springfield, TN
  • NPI 1316090145
  NPD
• State of Tennessee

  dba Upper Cumberland Regional Clinic

  • Public Health or Welfare Agency
  • Cookeville, TN
  • NPI 1598817017
  NPD
• Livingston Regional Hospital LLC

  dba Livingston Regional Hospital

  • Rural Acute Care Hospital
  • Livingston, TN
  • NPI 1396760542
  NPD (past)
• Medical Observation Services LLC

  • Emergency Medicine Physician
  • Cookeville, TN
  • NPI 1669734877
  NPD (past)
• Volunteer Medical Group, P.C.

  • Emergency Medicine Physician
  • Cookeville, TN
  • NPI 1801886999
  NPD (past)

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1720082548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 ENGLAND DR",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385010924",
            "telephone_number": "931-528-7531",
            "fax_number": "931-520-0413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 S MAIN ST",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385555967",
            "telephone_number": "931-484-6196",
            "fax_number": "931-456-1047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 County Services Dr",
            "address_purpose": "LOCATION",
            "city": "Cookeville",
            "state": "TN",
            "postal_code": "385014338",
            "country_code": "US",
            "telephone_number": "931-520-2531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "21614",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TN",
            "license": "MD21614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4129250",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Crossville, TN
• Providers in Crossville, TN by specialty
• General Practice Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.