Active NPI
Douglas Glynn Bolitho, M.D.
- Plastic Surgery Physician
- La Jolla, CA
National Provider Identifier
1740488196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- A69572
- Practice address
- 9834 Genesee Ave
311
La Jolla, CA 92037-1223 - Phone
- (858) 458-5100
- Fax
- (858) 458-1550
- NPI assigned
- Jul 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | A69572 | CA | Primary |
Addresses
Primary practice location
9834 Genesee Ave
311
La Jolla, CA 92037-1223
Mailing address
9834 Genesee Ave
311
La Jolla, CA 92037-1223
Phone (858) 458-5100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2015 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 69572 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scripps Health | Current | Accepting new patients | |
| Scripps Plastic Surgery Medical Group Inc | Plastic Surgery | Past | Accepting new patients |
| Retina San Diego | Past | Accepting new patients |
Interoperability endpoints
- dbolitho31766@scrippshlth.medalliesdirect.net
Organizations & group practices 3
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.
-
- Plastic Surgery Physician
- La Jolla, CA
- NPI 1164510350
Plastic Surgery
-
- General Acute Care Hospital
- San Diego, CA
- NPI 1487928891
-
- Ophthalmology Physician
- Encinitas, CA
- NPI 1235522319
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740488196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9834 GENESEE AVE",
"address_2": "311",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920371223",
"telephone_number": "858-458-5100",
"fax_number": "858-458-1550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9834 GENESEE AVE",
"address_2": "311",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920371223",
"telephone_number": "858-458-5100",
"fax_number": "858-458-1550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLITHO",
"first_name": "DOUGLAS",
"middle_name": "GLYNN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "CA",
"license": "A69572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.