NPIMap

Individual provider Active NPI

Kyle Boltson

  • Family Medicine Physician
  • Port Saint Lucie, FL
National Provider Identifier
1790363158
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS20226 Issued in FL
Practice address
1700 SE Hillmoor Dr Ste 500
Port Saint Lucie, FL 34952-7536
Phone
(772) 873-1770
NPI assigned
Mar 29, 2021
Last updated
Feb 25, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS20226 FL Primary

Addresses

Primary practice location

1700 SE Hillmoor Dr Ste 500
Port Saint Lucie, FL 34952-7536

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kyle.boltson.1@29601.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240703000651 FL Practitioner - Family Practice 0042612269 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Conviva Medical Center Management, LLCGroup PAC ID 4284717422, 507 clinicians

Practice addresses (Care Compare)

1700 SE Hillmoor Dr
Suite 500
Port St Lucie, FL 34952-7536
Phone (772) 873-1781

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Conviva Medical Center Management LLC Family Medicine CurrentSince Oct 13, 2025 Accepting new patients
Patel Medical Consulting, LLC Family Medicine CurrentSince Jun 1, 2024 Accepting new patients

Locations

6221 N Federal Hwy
Ft Lauderdale, FL 33308
Phone (954) 491-1686

440 W 49th St
Hialeah, FL 33012
Phone (305) 828-5000

17781 Thelma Ave
Jupiter, FL 33458
Phone (561) 746-2998

6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836

1700 SE Hillmoor Dr
Ste 500
Port St Lucie, FL 34952
Phone (772) 335-3200

Interoperability endpoints

  • Direct secure messaging: kyle.boltson.1@29601.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1790363158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 SE HILLMOOR DR STE 500",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527536",
            "telephone_number": "772-873-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTSON",
        "first_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-29",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS20226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kyle.boltson.1@29601.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1700 SE Hillmoor Dr Ste 500",
            "city": "Port Saint Lucie",
            "state": "FL",
            "country_code": "US",
            "postal_code": "349527536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

Verify at the official NPI Registry.