SAMUEL A. BOLIVAR, MD INC
NPI 1689082711
Clinic/Center - Primary Care in San Bernardino, CA
About Samuel A. Bolivar, Md Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMUEL A. BOLIVAR, MD INC (NPI 1689082711) is a healthcare organization registered as a primary care in San Bernardino, California and active in the NPI registry since August 2014. The organization maintains 2 additional practice locations and lists Barbara Bolivar, Administrator, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 2
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Samuel A. Bolivar, Md Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Samuel A. Bolivar, MD Inc, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 Samuel A. Bolivar, MD Inc's NPI number?
The NPI number for Samuel A. Bolivar, MD Inc is 1689082711. It was assigned to this organization in the NPPES registry on August 1, 2014.
Where is Samuel A. Bolivar, MD Inc located?
Samuel A. Bolivar, MD Inc is located at 555 N D St Suite 130, San Bernardino, CA 92401. The listed phone number is (909) 888-8154.
What is Samuel A. Bolivar, MD Inc's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Samuel A. Bolivar, MD Inc enrolled in Medicare?
Yes. Samuel A. Bolivar, MD Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Samuel A. Bolivar, MD Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Samuel A. Bolivar, MD Inc. 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 Samuel A. Bolivar, MD Inc was last updated on July 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.
# Samuel A. Bolivar, Md Inc · NPI 1689082711
Primary Care organization in San Bernardino, California. Organization record, active in the CMS NPPES registry since August 1, 2014.
## Identity
- **NPI:** 1689082711 (Entity type: Organization)
- **Enumerated:** August 1, 2014
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Barbara Bolivar, ADMINISTRATOR
## Practice location
- **Address:** 555 N D ST, SUITE 130, San Bernardino, CA 92401-1305
- **Phone:** (909) 888-8154 · **Fax:** (909) 888-9940
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Internal Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 1, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1689082711) · Data from the CMS NPPES public registry.