NPIMap

Organization Active NPI

Bolivar Family Medical Clinic a Medical Corporation

  • General Practice Physician
  • San Bernardino, CA
National Provider Identifier
1740507607
Registry record updated May 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
BOLIVAR FAMILY MEDICAL CLINIC A MEDICAL CORPORATION
Practice address
598 N F St
San Bernardino, CA 92410-3110
Phone
(909) 888-5552
Fax
(909) 884-7530
NPI assigned
Apr 30, 2010
Last updated
May 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2013

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

Authorized official

Name
Alvaro Bolivar, MDNPI 1477578698
Title
Owner
Phone
(909) 888-5552

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

598 N F St
San Bernardino, CA 92410-3110

Mailing address

598 N F St
San Bernardino, CA 92410-3110
Phone (909) 888-5552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050707000970 CA Part B Supplier - Clinic/Group Practice 4880630102 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riverside, CA; San Bernardino, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1272585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369180800000",
    "number": "1740507607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "598 N F ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924103110",
            "telephone_number": "909-888-5552",
            "fax_number": "909-884-7530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "598 N F ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924103110",
            "telephone_number": "909-888-5552",
            "fax_number": "909-884-7530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLIVAR FAMILY MEDICAL CLINIC A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-30",
        "last_updated": "2013-05-22",
        "status": "A",
        "authorized_official_last_name": "BOLIVAR",
        "authorized_official_first_name": "ALVARO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-888-5552",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.