Individual provider Active NPI

Stephanie Lauralynn Bolton, M.D.

  • Psychiatry Physician
  • Redlands, CA
National Provider Identifier
1790709095
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A89346 Issued in CA
Practice address
1686 Barton Rd Ste D
Redlands, CA 92373-1489
Phone
(909) 558-9542
NPI assigned
Jul 27, 2006
Last updated
Dec 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A89346 CA Primary

Addresses

Primary practice location

1686 Barton Rd Ste D
Redlands, CA 92373-1489

Mailing address

1686 Barton Rd Ste D
Redlands, CA 92373-1489
Phone (909) 558-9542

Other practice location 1

11374 Mountain View Ave
Suite A
Loma Linda, CA 92354-3815
Phone (909) 558-4505

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20070911000843 CA Practitioner - Psychiatry 9032202718 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A89346CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 12, 2010 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Psychiatry CurrentSince Jun 15, 2007 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jun 15, 2007 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 12, 2010 Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

11374 Mountain View Ave
Ste A
Loma Linda, CA 92354
Phone (909) 478-0078

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

1686 Barton Rd
Redlands, CA 92373
Phone (909) 558-9200

1686 Barton Rd
Ste D
Redlands, CA 92373
Phone (909) 558-9542

1710 Barton Rd
Redlands, CA 92373
Phone (909) 558-5075

Interoperability endpoints

  • Direct secure messaging: sbolton5431@direct.llu.edu

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1790709095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1686 BARTON RD STE D",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923731489",
            "telephone_number": "909-558-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1686 BARTON RD STE D",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923731489",
            "telephone_number": "909-558-9542"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11374 Mountain View Ave",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Loma Linda",
            "state": "CA",
            "postal_code": "923543815",
            "country_code": "US",
            "telephone_number": "909-558-4505",
            "fax_number": "909-558-6093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "STEPHANIE",
        "middle_name": "LAURALYNN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A89346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

Verify at the official NPI Registry.