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GARY G. BOLTON, M. D., P. A.
NPI 1205067188
Clinic/Center in Ridgeland, MS

Active since July 27, 2009
305 HIGHLAND PARK COVE, RIDGELAND, MS 39157(601) 206-9433 Get Directions Write a Review

NPPES record last updated: July 27, 2009. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Gary G. Bolton, M. D., P. A. NPPES

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

GARY G. BOLTON, M. D., P. A. (NPI 1205067188) is a healthcare organization registered as a clinic/center in Ridgeland, Mississippi and active in the NPI registry since July 2009. The organization lists Gary G Bolton, President, as its authorized official.

NPPES Registry Identity

NPI1205067188
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameGARY G. BOLTON, M. D., P. A.
Location Address305 HIGHLAND PARK COVERidgeland, MS 39157-6059
Mailing Address305 Highland Park CoveRidgeland, MS 39157-6059
Phone(601) 206-9433
Organization SubpartNo
Authorized OfficialGary G BoltonPresident · (601) 206-9433
Enumeration DateJuly 27, 2009
✔ NPI 1205067188 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in MS · 10243
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
305 HIGHLAND PARK COVE, Ridgeland, MS 39157
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Other Identifiers 2

Medicaid00111886MS
Medicare PIN070000036

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gary G. Bolton, M. D., P. A. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateMississippiEnrollment IDO20100217000639Non-DME Part B · Clinic/Group PracticeDue dateNovember 30, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Gary G. Bolton, M. D., P. A., which bills Medicare for the services this clinician delivers.

Clinician (1)

Gary Bolton, M. D.
Dermatology
NPI 1972620797
305 HIGHLAND PARK CV
Ridgeland, MS 39157
(601) 206-9433
✔ PECOS0.2 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Gary G. Bolton, M. D., P. A.'s NPI number?

The NPI number for Gary G. Bolton, M. D., P. A. is 1205067188. It was assigned to this organization in the NPPES registry on July 27, 2009.

Where is Gary G. Bolton, M. D., P. A. located?

Gary G. Bolton, M. D., P. A. is located at 305 Highland Park Cove, Ridgeland, MS 39157. The listed phone number is (601) 206-9433.

What is Gary G. Bolton, M. D., P. A.'s specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is Gary G. Bolton, M. D., P. A. enrolled in Medicare?

Yes. Gary G. Bolton, M. D., P. A. is registered in the Medicare PECOS enrollment system.

When is Gary G. Bolton, M. D., P. A.'s Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Mississippi, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Gary G. Bolton, M. D., P. A.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Gary G. Bolton, M. D., P. A.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Gary G. Bolton, M. D., P. A. was last updated on July 27, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.