Physician Compare National (NPI:1265404925)

HEALTHCARE PROVIDER: JOHN WILLIAM BOLEN JR. MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1265404925
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587619317
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091217000287
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOLEN
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GALAX RADIOLOGY, INC.
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	8224083050
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	200 HOSPITAL DR
	Group Practice or individual's line 1 address
City	GALAX
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	243332227
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2762368181
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490115
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TWIN COUNTY REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	340014
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NOVANT HEALTH FORSYTH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	340047
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	NORTH CAROLINA BAPTIST HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y