Sandra H Bolanos, MD, PHD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME137622 Issued in FL

Practice address

1730 SW Saint Lucie West Blvd
Port Saint Lucie, FL 34986-2504

Phone

(772) 873-8155

NPI assigned

Jul 9, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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

Specialty

Family Practice

Education

University of Texas Southwestern Medical School at Dallas, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Indian River Health Services IncGroup PAC ID 9234130329, 335 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cleveland Clinic Indian River Hospital Hospital, Vero Beach, FL, CCN 100105
• Cleveland Clinic Martin North Hospital Hospital, Stuart, FL, CCN 100044
• Cleveland Clinic Hospital, Cleveland, OH, CCN 360180

Merit-based Incentive Payment System (MIPS)

Final score

92.26 of 100Reported as apm

Quality

80.2

Promoting interoperability

99.24

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Indian River Health Services Inc

  • Psychiatry Physician
  • Vero Beach, FL
  • NPI 1710933031
  Medicare reassignment Care Compare group NPD
• Indian River Health Services Inc

  • Urgent Care Clinic/Center
  • Vero Beach, FL
  • NPI 1720319809
  NPD
• Heathrow Internal Medicine LLC

  • Family Medicine Physician
  • Lake Mary, FL
  • NPI 1033387865
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Indian River Memorial Hospital Inc

  • General Acute Care Hospital
  • Vero Beach, FL
  • NPI 1376512988
  Care Compare affiliation
• Martin Memorial Medical Center Inc

  • General Acute Care Hospital
  • Stuart, FL
  • NPI 1194790055
  Care Compare affiliation
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Care Compare affiliation

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552176000000",
    "number": "1992968853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 SW SAINT LUCIE WEST BLVD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862504",
            "telephone_number": "772-873-8155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 SW SAINT LUCIE WEST BLVD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862504",
            "telephone_number": "772-873-8155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3745 Holland Rd",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234522847",
            "country_code": "US",
            "telephone_number": "757-395-1700",
            "fax_number": "757-507-9004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLANOS",
        "first_name": "SANDRA",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-09",
        "last_updated": "2019-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "VA",
            "license": "89982967",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116019794",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME137622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bloom Health
• Blooming Hope Behavioral LLC
• Blue Harmony Therapy Inc
• Michael A Blum, D.O.
• Body Language by Theresa LLC
• Karissa Bolden, LMHC
• Wesley Bolitho, MS, CCC-SLP
• Kyle Boltson
• Yonahil M Bonalde
• Bonnie'S Group Hpme

• Family Medicine Physician in Port Saint Lucie, FL
• Providers in Port Saint Lucie, 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 Mar 10, 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.
• 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.