Jeremy E Bolluyt, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

3326 Issued in IA

Practice address

2700 23Rd St
Suite C
Spirit Lake, IA 51360-1158

Phone

(712) 336-3750

Fax

(712) 336-3730

NPI assigned

Jan 26, 2006

Last updated

Nov 6, 2007By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194307200000",
    "number": "1760452205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 23RD ST",
            "address_2": "SUITE C",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "513601158",
            "telephone_number": "712-336-3750",
            "fax_number": "712-336-3730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 23RD ST",
            "address_2": "SUITE C",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "513601158",
            "telephone_number": "712-336-3750",
            "fax_number": "712-336-3730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLUYT",
        "first_name": "JEREMY",
        "middle_name": "E",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2007-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "3326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1187948",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Banks
• Steven L Baskerville, M.D.
• Sarah Berte-Greinert, LISW
• Charles Arthur Birkland
• Courtney N Bolluyt, PA-C
• Zachary A Borus, MD
• Jessica Braun, PT, DPT
• Breaking Illusions Counseling LLC
• Brittany Brennan, MA, CCC-SLP
• Hannah Rae Buffington

• Family Medicine Physician in Spirit Lake, IA
• Providers in Spirit Lake, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.