Individual provider Active NPI

Jeffrey Albert Bollig, DPT

  • Physical Therapist
  • Statesboro, GA
National Provider Identifier
1760134035
Registry record updated Jan 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT015322 Issued in GA
Practice address
16915 Highway 67 Ste a
Statesboro, GA 30458-5819
Phone
(912) 681-2500
NPI assigned
Jan 19, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT015322 GA Primary

Addresses

Primary practice location

16915 Highway 67 Ste a
Statesboro, GA 30458-5819

Mailing address

809 Coursey Landing Rd
Newington, GA 30446-2325
Phone (912) 857-4017

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220415000381 GA Practitioner - Physical Therapist in Private Practice 7012303266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optim Orthopedics LLCGroup PAC ID 9931427002, 101 clinicians

Practice addresses (Care Compare)

17007 Hwy 67
Statesboro, GA 30458-2426
Phone (912) 681-2500

210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT015322GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Optim Orthopedics, LLC CurrentSince Jan 13, 2022 Accepting new patients
Optim Orthopedics, LLC CurrentSince Jan 13, 2022 Accepting new patients
Optim Orthopedics, LLC PastSince Oct 6, 2019 Accepting new patients
Optim Orthopedics, LLC Past Accepting new patients

Locations

210 E Derenne Ave
Savannah, GA 31405
Phone (912) 355-0140

16915 Highway 67
#A
Statesboro, GA 30458
Phone (912) 681-2500

Interoperability endpoints

  • Direct secure messaging: jeffrey.bollig.1@16403.direct.athenahealth.com

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1760134035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 COURSEY LANDING RD",
            "city": "NEWINGTON",
            "state": "GA",
            "postal_code": "304462325",
            "telephone_number": "912-857-4017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16915 HIGHWAY 67 STE A",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585819",
            "telephone_number": "912-681-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLIG",
        "first_name": "JEFFREY",
        "middle_name": "ALBERT",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.