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JACOB THOMAS BOLZ PA-C
NPI 1386025682
Physician Assistant in Lakeside, CA

Active since June 11, 2015PECOS Enrolled
12517 LAKESHORE DR, LAKESIDE, CA 92040(619) 443-3843 Get Directions Write a Review

NPPES record last updated: June 11, 2015. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jacob Thomas Bolz Pa-c NPPES

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

JACOB THOMAS BOLZ PA-C (NPI 1386025682) is an individual physician assistant in Lakeside, California, licensed in California (52510) and active in the NPI registry since June 2015. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1386025682
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameJACOB THOMAS BOLZCredential: PA-C
Location Address12517 LAKESHORE DRLakeside, CA 92040-3103
Mailing Address12517 Lakeshore DrLakeside, CA 92040-3103 · (619) 443-3843
Phone(619) 443-3843
Sole ProprietorNo
Enumeration DateJune 11, 2015
✔ NPI 1386025682 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CA · 52510
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
12517 LAKESHORE DR, Lakeside, CA 92040
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacob Thomas Bolz Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92040 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$76.87 typical visit price
range $20.62 – $151.42
Typical copayment $19.21 (range $5.15 – $37.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. LARRY J MARSHALL MD
Family Medicine
12517 LAKESHORE DR
LAKESIDE, CA 92040
San Diego County (619) 443-3843
DR. VICTOR MANUEL MENDOZA-FERNANDEZ
Family Medicine
12517 LAKESHORE DR
LAKESIDE, CA 92040
San Diego County (619) 443-3843
LARRY J MARSHALL MD A PROFESSIONAL CORPORATION
General Practice
12517 LAKESHORE DR
LAKESIDE, CA 92040
San Diego County (619) 443-3843

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 Jacob Bolz's NPI number?

The NPI number for Jacob Bolz is 1386025682. It was assigned to this individual provider in the NPPES registry on June 11, 2015.

Where is Jacob Bolz located?

Jacob Bolz practices at 12517 Lakeshore Dr, Lakeside, CA 92040. The listed phone number is (619) 443-3843.

What is Jacob Bolz's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Jacob Bolz enrolled in Medicare?

Yes. Jacob Bolz is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacob Bolz was last updated on June 11, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.