Kerilyn Bollmann, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25919 Issued in AZ

Practice address

11250 N Tatum Blvd Ste 103
Phoenix, AZ 85028-2306

Phone

(480) 460-8485

Fax

(480) 504-0520

NPI assigned

Apr 25, 2006

Sex

Female

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

Other names 1

• Dr. Kerilyn Gwisdalla Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 7, 2018 through Jun 7, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kerilyn.bollmann@109448942780420.direct.elationemr.com

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.

• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1982660155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11250 N TATUM BLVD STE 103",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850282306",
            "telephone_number": "480-460-8485",
            "fax_number": "480-504-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11250 N TATUM BLVD STE 103",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850282306",
            "telephone_number": "480-460-8485",
            "fax_number": "480-504-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLMANN",
        "first_name": "KERILYN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "25919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "457673",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERILYN",
            "last_name": "GWISDALLA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Lynn Bolger, SLP
• Matthew Gordon Boliaux, DO
• Padmaja Bollam, M.D.
• Tanner Bollig
• Mayleen Rae Bollinger, BSN
• April Lee Bolton, R.D.N.
• Brandon Lee Bolton, RDN
• Patrick Bradford Bolton, MD
• Tymon Nakia Bolton
• Mandy Boltz, MD

• Internal Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.