Individual provider Active NPI

Islam Abbas Bolad, MD

  • Cardiovascular Disease Physician
  • Lafayette, IN
National Provider Identifier
1780746198
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
01064026A Issued in IN
Practice address
3900 St Francis Way Ste 200
Lafayette, IN 47905-4940
Phone
(765) 775-2800
Fax
(765) 775-2831
NPI assigned
Dec 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01064026A IN
Interventional Cardiology Physician 207RI0011X 016813 ME
Cardiovascular Disease Physician 207RC0000X 01064026A IN Primary

Addresses

Primary practice location

3900 St Francis Way Ste 200
Lafayette, IN 47905-4940

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other practice location 1

1481 W 10th St
Indianapolis, IN 46202-2803
Phone (317) 988-2501

Other identifiers 1

IdentifierTypeStateIssuer
200881960MedicaidIN

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20071221000438 IN Practitioner - Cardiovascular Disease (Cardiology) 1052401437 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

3900 St Francis Way
Suite 200
Lafayette, IN 47905-4923
Phone (765) 463-2399

Hospital & facility affiliations

  • Franciscan Health Lafayette Hospital, Lafayette, IN, CCN 150109
  • Franciscan Health Crawfordsville Hospital, Crawfordsville, IN, CCN 150022
  • Franciscan Health Rensselaer, Inc Hospital, Rensselaer, IN, CCN 151324
  • Memorial Hospital Hospital, Logansport, IN, CCN 150072
  • Franciscan Health Indianapolis Hospital, Indianapolis, IN, CCN 150162

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01064026AINMDCardiovascular Disease Physician
016813MEMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network Internal Medicine CurrentSince Jan 1, 2023 Accepting new patients
Franciscan Physician Network CurrentSince Jan 1, 2023 Accepting new patients

Locations

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

1710 Lafayette Rd
Crawfordsvlle, IN 47933
Phone (765) 362-2800

3900 St Francis Way
Ste 200
Lafayette, IN 47905
Phone (765) 775-2800

1104 E Grace St
Rensselaer, IN 47978
Phone (219) 866-2026

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676592000000",
    "number": "1780746198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 ST FRANCIS WAY STE 200",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054940",
            "telephone_number": "765-775-2800",
            "fax_number": "765-775-2831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1481 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462022803",
            "country_code": "US",
            "telephone_number": "317-988-2501",
            "fax_number": "317-988-3243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLAD",
        "first_name": "ISLAM",
        "middle_name": "ABBAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01064026A",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "ME",
            "license": "016813",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01064026A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200881960",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.