Bontaya Calvin, CERTIFIED HAIRLOSS

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

License

157804 Issued in TN

Practice address

4305 Harvest Hill Rd
Memphis, TN 38141-6933

Phone

(901) 236-9256

NPI assigned

Aug 14, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Bontaya Calvin Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597363200000",
    "number": "1982215778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4305 HARVEST HILL RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381416933",
            "telephone_number": "901-652-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 HARVEST HILL RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381416933",
            "telephone_number": "901-236-9256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALVIN",
        "first_name": "BONTAYA",
        "credential": "CERTIFIED HAIRLOSS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-14",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "TN",
            "license": "157804",
            "primary": false
        },
        {
            "code": "1744P3200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "TN",
            "license": "157804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Internet",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4305 Harvest Hill Rd",
            "city": "Memphis",
            "state": "TN",
            "country_code": "US",
            "postal_code": "381416933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "BONTAYA",
            "last_name": "CALVIN",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Prosthetics Case Management in Memphis, TN
• Providers in Memphis, TN by specialty
• Prosthetics Case Management in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.