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PAVAN BOLLA MD
NPI 1790670834
Student in an Organized Health Care Education/Training Program in Utica, NY

Active since June 10, 2025PECOS EnrolledAccepts Medicare Assignment
120 HOBART ST, UTICA, NY 13501(315) 798-1149(315) 801-3565 Get Directions Write a Review

NPPES record last updated: April 9, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 9, 2026, Jun 10, 2025 (2 updates tracked since 2025).

About Pavan Bolla Md NPPES

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

PAVAN BOLLA MD (NPI 1790670834) is an individual student in an organized health care education/training program in Utica, New York and active in the NPI registry since June 2025. He is enrolled in Medicare PECOS and is a graduate of Other (2013).

NPPES Registry Identity

NPI1790670834
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NamePAVAN BOLLACredential: MD
Location Address120 HOBART STUtica, NY 13501-4308
Mailing Address111 Hospital DrUtica, NY 13502-2517 · (315) 624-6100
Phone(315) 798-1149
Fax(315) 801-3565
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateJune 10, 2025
Last NPPES UpdateApril 9, 20262 updates tracked since enumeration
NPPES CertifiedApril 9, 2026
✔ NPI 1790670834 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
120 HOBART ST, Utica, NY 13501
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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 and accepts Medicare assignment

Pavan Bolla Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8921513169
PECOS Enrollment IDI20250716000665
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.

Other Providers at the Same Location NPPES 20

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

VIRENDRA SHARMA MD
Hospitalist
120 HOBART ST
UTICA, NY 13501
Oneida County (315) 798-1149
YANET MARTINEZ MD
Student in an Organized Health Care Education/Training Program
120 HOBART ST
UTICA, NY 13501
Oneida County (315) 798-1149
JULIE BETRO SHKANE DO
Family Medicine
120 HOBART ST
UTICA, NY 13501
Oneida County (315) 798-1149
EMILY HSU JOSLIN MD
Family Medicine
120 HOBART ST
UTICA, NY 13501
Oneida County (315) 797-1149
THET THET MAR NP
Nurse Practitioner (Family)
120 HOBART ST
UTICA, NY 13501
Oneida County (315) 798-1149
GYASI KODUA MD
Student in an Organized Health Care Education/Training Program
120 HOBART ST
UTICA, NY 13501
Oneida County (315) 798-1149
SHYQUAL M LEWIS MD
Emergency Medicine
120 HOBART ST
UTICA, NY 13501
Oneida County (315) 798-1149
SUN YOO MD
Family Medicine
120 HOBART ST
UTICA, NY 13501
Oneida County (315) 798-1149

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 Pavan Bolla's NPI number?

The NPI number for Pavan Bolla is 1790670834. It was assigned to this individual provider in the NPPES registry on June 10, 2025.

Where is Pavan Bolla located?

Pavan Bolla practices at 120 Hobart St, Utica, NY 13501. The listed phone number is (315) 798-1149.

What is Pavan Bolla's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Pavan Bolla enrolled in Medicare?

Yes. Pavan Bolla is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Pavan Bolla was last updated on April 9, 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.