NPIMap

Individual provider Active NPI

Carla Prince Bolivar, M.D.

  • Internal Medicine Physician
  • Farmington, MO
National Provider Identifier
1922233873
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2009022078 Issued in MO
Practice address
515 Maple Valley Dr
Farmington, MO 63640-1919
Phone
(573) 760-7920
Fax
(573) 756-9597
NPI assigned
May 21, 2009
Last updated
Mar 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2009022078 MO Primary

Addresses

Primary practice location

515 Maple Valley Dr
Farmington, MO 63640-1919

Mailing address

PO Box 801143
Kansas City, MO 64180-1143
Phone (573) 331-3000

Other names 1

  • Carla Prince Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20100123000217 MO Practitioner - Internal Medicine 3274675699 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Francis Medical CenterGroup PAC ID 9931007929, 441 clinicians

Practice addresses (Care Compare)

150 S Mount Auburn Rd
Cape Girardeau, MO 63703-5049

211 Saint Francis Dr
Cape Girardeau, MO 63703-5049

24 S Mount Auburn Rd
Cape Girardeau, MO 63703-5049

515 Maple Valley Dr
Farmington, MO 63640-1919
Phone (573) 760-7920

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
67.07 of 100Reported as apm
Quality
85.4
Promoting interoperability
0
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Francis Medical Center CurrentSince Jul 1, 2016 Accepting new patients
Cape Laboratory & Pathology, LC Current Accepting new patients
Saint Francis Medical Center CurrentSince Jul 1, 2016 Accepting new patients
Mineral Area Osteopathic Hospital Inc Internal Medicine Past Accepting new patients
Ferguson Medical Group Rural Health Center Inc. Past Accepting new patients

Locations

211 Saint Francis Dr
Cpe Girardeau, MO 63703
Phone (573) 331-3000

1212 Weber Rd
Farmington, MO 63640
Phone (573) 756-4581

515 Maple Valley Dr
Farmington, MO 63640
Phone (573) 760-7920

545 Broadridge Dr
Jackson, MO 63755
Phone (573) 243-1997

Interoperability endpoints

  • Direct secure messaging: cprince12982@surescripts.sfmc.net

Organizations & group practices 5

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 10

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": "1242864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1922233873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801143",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641801143",
            "telephone_number": "573-331-3000",
            "fax_number": "573-331-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 MAPLE VALLEY DR",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401919",
            "telephone_number": "573-760-7920",
            "fax_number": "573-756-9597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRINCE BOLIVAR",
        "first_name": "CARLA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-21",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2009022078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLA",
            "last_name": "PRINCE",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.