Gary Glenn Bolton, M. D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

10243 Issued in MS

Practice address

305 Highland Park CV
Ridgeland, MS 39157-6059

Phone

(601) 206-9433

Fax

(601) 206-5428

NPI assigned

Mar 25, 2007

Last updated

Apr 4, 2014By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Dermatology

Education

University of Mississippi School of Medicine, 1983

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gary G. Bolton, M. D., P. a.

  • Clinic/Center
  • Ridgeland, MS
  • NPI 1205067188
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396569600000",
    "number": "1972620797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 HIGHLAND PARK CV",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391576059",
            "telephone_number": "601-206-9433",
            "fax_number": "601-206-5428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 HIGHLAND PARK CV",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391576059",
            "telephone_number": "601-206-9433",
            "fax_number": "601-206-5428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "GARY",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-25",
        "last_updated": "2014-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MS",
            "license": "10243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00111886",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Blake Denton Boleware, DMD, MS
• Hayley Boleware, SLP
• Bond Pharmacy Inc (Advanced Infusion Solutions)
• Bond Pharmacy Inc. (Advanced Infusion Solutions)
• Darryl James Bonds II
• Karen Mori Bonner, LPC
• Bostwick Pathology

• Dermatology Physician in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Dermatology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; 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.