Pavan Bolla, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

120 Hobart St
Utica, NY 13501-4308

Phone

(315) 798-1149

Fax

(315) 801-3565

NPI assigned

Jun 10, 2025

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

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Internal Medicine

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Fresh Meadows Physician Practice PLLC

  • Internal Medicine Physician
  • Jamaica, NY
  • NPI 1720775083
  Medicare reassignment NPD
• Peyman Younesi MD PLLC

  • Internal Medicine Physician
  • Fresh Meadows, NY
  • NPI 1891053328
  Medicare reassignment NPD
• My Medical PC

  • Family Medicine Physician
  • Valley Cottage, NY
  • NPI 1518637891
  NPD

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

{
    "created_epoch": "1749513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775692800000",
    "number": "1790670834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HOSPITAL DR",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135022517",
            "telephone_number": "315-624-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HOBART ST",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135014308",
            "telephone_number": "315-798-1149",
            "fax_number": "315-801-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLA",
        "first_name": "PAVAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-10",
        "last_updated": "2026-04-09",
        "certification_date": "2026-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrice Anne Bogan, N.P.
• Jaclyn Marie Bogdan
• Aleksey V Bogolyubov, MD
• Ejub Bojadzija, PHARM.D
• Dshauna Lee Boles
• Samantha Bond, LMSW
• Karen Bone
• Deborah K Bongiorno, LPN
• Patricia Anne Bonner, LCSW
• Sam J Bono, OD

• Student in an Organized Health Care Education/Training Program in Utica, NY
• Providers in Utica, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.