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DR. JERRY BLAKE BOLIN M.D.
NPI 1174563043
Family Medicine in Frisco, TX

Active since June 07, 2006Opted out of Medicare · through Mar 2, 2027
3550 PARKWOOD BLVD., BLDG. D, STE. 405, FRISCO, TX 75034(469) 287-8800(469) 287-8801 Get Directions Write a Review

NPPES record last updated: December 31, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 31, 2020, Dec 21, 2020 (2 updates tracked since 2020).

About Dr. Jerry Blake Bolin M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JERRY BLAKE BOLIN M.D. (NPI 1174563043) is an individual family medicine provider in Frisco, Texas, licensed in Texas (K8014) and active in the NPI registry since June 2006. He has opted out of Medicare through March 2, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1174563043
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. JERRY BLAKE BOLINCredential: M.D.
Location Address3550 PARKWOOD BLVD., BLDG. D, STE. 405Frisco, TX 75034
Mailing Address3550 Parkwood Blvd., Bldg. D. Ste. 405Frisco, TX 75034 · (469) 287-8800 · Fax (469) 287-8801
Phone(469) 287-8800
Fax(469) 287-8801
Sole ProprietorYes
Enumeration DateJune 7, 2006
Last NPPES UpdateDecember 31, 20202 updates tracked since enumeration
NPPES CertifiedDecember 31, 2020
✔ NPI 1174563043 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in TX · K8014
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
3550 PARKWOOD BLVD., Frisco, TX 75034
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Other Names 1

Professional Name (2)Dr. J Blake Bolin Md

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jerry Blake Bolin M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 2, 2023 through March 2, 2027.

Opt-Out Effective DateMarch 2, 2023
Opt-Out In Effect ThroughMarch 2, 2027Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jerry Bolin's NPI number?

The NPI number for Jerry Bolin is 1174563043. It was assigned to this individual provider in the NPPES registry on June 7, 2006. The provider is also known as Dr. J Blake Bolin MD.

Where is Jerry Bolin located?

Jerry Bolin practices at 3550 Parkwood Blvd. Bldg. D, Ste. 405, Frisco, TX 75034. The listed phone number is (469) 287-8800.

What is Jerry Bolin's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Jerry Bolin enrolled in Medicare?

No. Jerry Bolin has opted out of Medicare through March 2, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jerry Bolin was last updated on December 31, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.