Mark Jolly, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME 100262 Issued in FL

Practice address

4201 14TH Ave E
Bradenton, FL 34208-5815

Phone

(941) 713-0728

NPI assigned

Mar 4, 2008

Sex

Male

Sole proprietor

Yes

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 FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650
  Medicare reassignment NPD
• Em Alliance LLC

  • Emergency Medicine Physician
  • Wellington, FL
  • NPI 1922788959
  NPD
• Two Rivers Medical

  • General Practice Physician
  • Bradenton, FL
  • NPI 1639062946
  NPD

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214179200000",
    "number": "1841460946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 14TH AVENUE EAST",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34208",
            "telephone_number": "941-713-0728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 14TH AVE E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085815",
            "telephone_number": "941-713-0728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLY",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-04",
        "last_updated": "2008-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME 100262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Johnson
• Barbara Ann Johnston, OTRL
• John Druilhett Johnston III, LCSW
• Steven Daniel Johnston, OTRL
• Joli Chateau, Inc.
• Jonathan a Adler MD PA
• Destiny Jean Jones, CNA
• Emmeral Jones
• Lindsey Jones
• Malorie Nicole Jones

• Family Medicine Physician in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.